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Journal of Medical Case Reports

, 10:2

First Online: 13 January 2016Received: 29 April 2015Accepted: 23 December 2015DOI: 10.1186-s13256-015-0794-2

Cite this article as: Pantazis, K., Roupas, N.D., Panagopoulos, A. et al. J Med Case Reports 2016 10: 2. doi:10.1186-s13256-015-0794-2

Abstract

BackgroundTendinitis can be a presenting complaint in hypothyroidism, with symptomatic relief being obtained by appropriate management of the primary thyroid deficiency. To the best of our knowledge no other cases of spontaneous rupture of the long head of the biceps tendon during uncontrolled hypothyroidism have yet been reported.

Case presentationThis case report describes an unusual case of spontaneous rupture of the long head of the biceps tendon in a 48-year-old white woman with severe hypothyroidism. She described experiencing a sudden sharp pain and an audible pop in her right shoulder while using her personal computer. On physical examination she was positive for Yergason’s sign and a subsequent magnetic resonance imaging scan showed complete rupture of the long head of her biceps tendon. Laboratory tests revealed significantly elevated thyrotropin levels >100 μIU-ml and very low levels of both triiodothyronine 0.17 ng-ml and free thyroxine 0.18 ng-dl. She was switched to a different thyroxin regimen with a progressive dosage increment. She declined surgical re-anchorage of the tendon but despite the discreet Popeye sign, her overall strength and shoulder function were satisfactory. After 2 months, she was found to be clinically euthyroid, having normal thyroid function tests thyrotropin 2.95 μIU-mL, free thyroxine 1.07 ng-dl. At her last follow-up visit, 1 year post-injury, she reported nearly normal shoulder function in her daily activities and had a constant shoulder score of 93 points.

ConclusionsThe role of thyroid hormones in the synthesis and degeneration of collagen and in the proliferation and apoptosis of human tenocytes is discussed, providing a possible mechanism whereby hypothyroidism may lead to tendon tears. This report may have a greater impact among different subspecialties as it presupposes a high degree of awareness from internists, endocrinologists and orthopedic surgeons.

KeywordsHypothyroidism Long head of biceps Tendon rupture Thyroid  Download fulltext PDF



Autor: K. Pantazis - N. D. Roupas - Andreas Panagopoulos - S. Theodoraki - A. Tsintoni - V. Kyriazopoulou

Fuente: https://link.springer.com/



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