Case and Research letter
Bilateral Eyelid Swelling Associated With Acute Hypothyroidism
Edema palpebral bilateral asociado a crisis hipotiroidea
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Salazar-Nievas, S. Arias-Santiago" "autores" => array:2 [ 0 => array:3 [ "nombre" => "M." "apellidos" => "Salazar-Nievas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "S." "apellidos" => "Arias-Santiago" "email" => array:1 [ 0 => "salvadorarias@hotmail.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Dermatología, Hospital Virgen de las Nieves, Granada, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Edema palpebral bilateral asociado a crisis hipotiroidea" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 733 "Ancho" => 550 "Tamanyo" => 83863 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Eyelid swelling 24<span class="elsevierStyleHsp" style=""></span>hours after onset. The lesion was neither warm to the touch nor painful and was more pronounced on the right.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The eyelid is subject to considerable deformity owing to the particular laxity of the subcutaneous cellular tissue, which is caused by infiltration of the interstitial spaces. The degree of swelling can range from simple tumefaction of the ciliary margin to a considerable increase in periocular tissue volume, which in some cases can lead to narrowing, or even closure, of the palpebral fissure. Differential diagnosis of eyelid swelling is complex. It requires a meticulous physical examination and inclusion of both inflammatory and noninflammatory causes. The main noninflammatory cause is acute hypothyroidism, as in the present case.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We describe the case of a 52-year-old woman who presented with a 1-week history of sudden-onset bilateral eyelid swelling that was neither painful nor pruriginous. Her personal history was remarkable for autoimmune hypothyroidism (Hashimoto thyroiditis) that first appeared 5 years previously and for which she was receiving hormone replacement therapy (levothyroxine 75<span class="elsevierStyleHsp" style=""></span>μg/d). She also had a 1-year history of autoimmune hepatitis, which was treated with prednisone (7.5<span class="elsevierStyleHsp" style=""></span>mg/d po), and hypertension, which was treated with enalapril (20<span class="elsevierStyleHsp" style=""></span>mg/d po). She attended our clinic with bilateral eyelid swelling that had begun 24<span class="elsevierStyleHsp" style=""></span>hours earlier. The patient had not ingested new drugs, experienced injury, received insect bites or stings, or applied cosmetic products to the area. Examination revealed soft bilateral edema that was more pronounced on the right side with discrete erythema and no crepitus, vesicles, or desquamation (<a class="elsevierStyleCrossRefs" href="#fig0005">Figs. 1 and 2</a>). Her visual acuity and eye movement were unaltered, and she had no skin lesions at other sites. The results of a full laboratory workup were normal, although thyroid-stimulating hormone (TSH) was 50.3<span class="elsevierStyleHsp" style=""></span>mIU/L and free thyroxine was diminished (0.5<span class="elsevierStyleHsp" style=""></span>ng/dL). The dose of levothyroxine was increased considerably (500<span class="elsevierStyleHsp" style=""></span>μg/d), as was that of oral prednisone (15<span class="elsevierStyleHsp" style=""></span>mg/d), to reduce inflammation. Seven days after the first visit, her TSH level had fallen to 35<span class="elsevierStyleHsp" style=""></span>mIU/L, thyroid hormone levels had returned to normal, and the swelling had improved considerably. A week later, the skin complaint was in total remission (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>) and the TSH concentration had fallen to 20<span class="elsevierStyleHsp" style=""></span>mIU/L.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The characteristics of the lesion and the clinical course confirmed a diagnosis of bilateral eyelid swelling associated with acute hypothyroidism.</p><p id="par0020" class="elsevierStylePara elsevierViewall">The differential diagnosis of eyelid swelling should include various clinical entities (<a class="elsevierStyleCrossRef" href="#fig0020">Fig. 4</a>). A careful evaluation should be made of the intensity, location (one or both eyelids), and coloring of the swelling. The initial examination first makes it possible to rule out swelling caused by trapped air, with its characteristic crunching snow sensation, and blood pooling in the case of hematoma. Finally, it is necessary to define whether the swelling is inflammatory or noninflammatory and analyze the possible causes.</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">Eyelid swelling associated with hypothyroidism is uncommon and can occasionally mimic other conditions such as angioedema, bites and stings, and contact dermatitis.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> In the case we describe, the absence of induration, vesicles, and pruritus make a diagnosis of eczema or angioedema unlikely; in addition, the patient's clinical condition improved considerably when the acute hypothyroidism resolved. The causes of swelling are not well known, although mucopolysaccharide deposits play a role. Case reports show that eyelid swelling is a clinical sign of severe acute hypothyroidism. It is sometimes more subtle, is associated with thinning of the eyebrows,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> and, in some cases, can manifest as palpebral redundancy resulting from laxity of the eyelid.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The swelling resolves gradually with treatment of hypothyroidism.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Eyelid swelling is not the only dermatologic manifestation associated with hypothyroidism, and other more common presentations sometimes go unnoticed. In more than 80% of cases the epidermis is thin, dry, rough, hyperkeratotic, and covered with fine superficial scales.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The hair is opaque, rough, and brittle, partly owing to reduced secretion of sebum. Alopecia has been reported in up to 50% of patients and can be diffuse or partial; the nails are thin and fragile with striations and horizontal and longitudinal ridges.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Finally, in the case of sudden-onset asymptomatic bilateral soft swelling in which dermatitis and angioedema can be ruled out, systemic causes such as hypothyroidism should be suspected. Therefore, eyelid swelling can be a sign of numerous local and systemic diseases and requires a meticulous clinical workup in order to determine the cause and enable appropriate treatment to be started.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Salazar-Nievas M, Arias-Santiago S. Edema palpebral bilateral asociado a crisis hipotiroidea. Actas Dermosifiliogr. 2014;105:427–429.</p>" ] ] "multimedia" => array:4 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 733 "Ancho" => 550 "Tamanyo" => 83863 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Eyelid swelling 24<span class="elsevierStyleHsp" style=""></span>hours after onset. The lesion was neither warm to the touch nor painful and was more pronounced on the right.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 666 "Ancho" => 888 "Tamanyo" => 95203 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Bilateral palpebral swelling involving the nasal root 72<span class="elsevierStyleHsp" style=""></span>hours after onset.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figure 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 294 "Ancho" => 750 "Tamanyo" => 46109 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Swelling resolved after improvement of acute hypothyroidism.</p>" ] ] 3 => array:7 [ "identificador" => "fig0020" "etiqueta" => "Figure 4" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr4.jpeg" "Alto" => 1279 "Ancho" => 1829 "Tamanyo" => 255205 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Diagnostic algorithm for palpebral swelling.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:7 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Alonso Caviedes S, Collado Hornillos JA, Gómez Dacasa A. 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Jabbour" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Am J Clin Dermatol" "fecha" => "2003" "volumen" => "4" "paginaInicial" => "315" "paginaFinal" => "331" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12688837" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/15782190/0000010500000004/v1_201404301027/S1578219014000912/v1_201404301027/en/main.assets" "Apartado" => array:4 [ "identificador" => "6157" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Case and Research Letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/15782190/0000010500000004/v1_201404301027/S1578219014000912/v1_201404301027/en/main.pdf?idApp=UINPBA000044&text.app=https://actasdermo.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1578219014000912?idApp=UINPBA000044" ]
| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Noviembre | 24 | 8 | 32 |
| 2024 Octubre | 219 | 63 | 282 |
| 2024 Septiembre | 214 | 48 | 262 |
| 2024 Agosto | 243 | 87 | 330 |
| 2024 Julio | 174 | 59 | 233 |
| 2024 Junio | 201 | 45 | 246 |
| 2024 Mayo | 163 | 45 | 208 |
| 2024 Abril | 140 | 33 | 173 |
| 2024 Marzo | 177 | 38 | 215 |
| 2024 Febrero | 235 | 36 | 271 |
| 2024 Enero | 210 | 45 | 255 |
| 2023 Diciembre | 267 | 47 | 314 |
| 2023 Noviembre | 340 | 56 | 396 |
| 2023 Octubre | 315 | 48 | 363 |
| 2023 Septiembre | 349 | 75 | 424 |
| 2023 Agosto | 236 | 45 | 281 |
| 2023 Julio | 284 | 70 | 354 |
| 2023 Junio | 234 | 50 | 284 |
| 2023 Mayo | 256 | 91 | 347 |
| 2023 Abril | 256 | 56 | 312 |
| 2023 Marzo | 292 | 59 | 351 |
| 2023 Febrero | 225 | 44 | 269 |
| 2023 Enero | 230 | 64 | 294 |
| 2022 Diciembre | 267 | 51 | 318 |
| 2022 Noviembre | 225 | 53 | 278 |
| 2022 Octubre | 221 | 62 | 283 |
| 2022 Septiembre | 185 | 77 | 262 |
| 2022 Agosto | 107 | 54 | 161 |
| 2022 Julio | 155 | 71 | 226 |
| 2022 Junio | 155 | 39 | 194 |
| 2022 Mayo | 217 | 86 | 303 |
| 2022 Abril | 183 | 77 | 260 |
| 2022 Marzo | 163 | 113 | 276 |
| 2022 Febrero | 144 | 58 | 202 |
| 2022 Enero | 138 | 67 | 205 |
| 2021 Diciembre | 150 | 82 | 232 |
| 2021 Noviembre | 164 | 103 | 267 |
| 2021 Octubre | 134 | 84 | 218 |
| 2021 Septiembre | 117 | 79 | 196 |
| 2021 Agosto | 97 | 82 | 179 |
| 2021 Julio | 98 | 53 | 151 |
| 2021 Junio | 76 | 66 | 142 |
| 2021 Mayo | 77 | 82 | 159 |
| 2021 Abril | 180 | 83 | 263 |
| 2021 Marzo | 81 | 46 | 127 |
| 2021 Febrero | 61 | 45 | 106 |
| 2021 Enero | 43 | 56 | 99 |
| 2020 Diciembre | 60 | 41 | 101 |
| 2020 Noviembre | 40 | 38 | 78 |
| 2020 Octubre | 47 | 43 | 90 |
| 2020 Septiembre | 47 | 24 | 71 |
| 2020 Agosto | 33 | 28 | 61 |
| 2020 Julio | 36 | 32 | 68 |
| 2020 Junio | 39 | 16 | 55 |
| 2020 Mayo | 32 | 30 | 62 |
| 2020 Abril | 31 | 30 | 61 |
| 2020 Marzo | 29 | 29 | 58 |
| 2020 Febrero | 6 | 16 | 22 |
| 2020 Enero | 6 | 12 | 18 |
| 2019 Diciembre | 8 | 14 | 22 |
| 2019 Noviembre | 4 | 12 | 16 |
| 2019 Octubre | 0 | 9 | 9 |
| 2019 Septiembre | 4 | 11 | 15 |
| 2019 Agosto | 4 | 11 | 15 |
| 2019 Julio | 4 | 28 | 32 |
| 2019 Junio | 4 | 17 | 21 |
| 2019 Mayo | 6 | 20 | 26 |
| 2019 Abril | 2 | 18 | 20 |
| 2019 Marzo | 4 | 8 | 12 |
| 2019 Febrero | 0 | 3 | 3 |
| 2019 Enero | 2 | 1 | 3 |
| 2018 Diciembre | 2 | 8 | 10 |
| 2018 Noviembre | 1 | 0 | 1 |
| 2018 Octubre | 2 | 0 | 2 |
| 2018 Septiembre | 4 | 3 | 7 |
| 2018 Agosto | 0 | 15 | 15 |
| 2018 Julio | 0 | 6 | 6 |
| 2018 Junio | 0 | 8 | 8 |
| 2018 Mayo | 0 | 12 | 12 |
| 2018 Marzo | 31 | 8 | 39 |
| 2018 Febrero | 129 | 6 | 135 |
| 2018 Enero | 108 | 9 | 117 |
| 2017 Diciembre | 144 | 15 | 159 |
| 2017 Noviembre | 131 | 10 | 141 |
| 2017 Octubre | 113 | 5 | 118 |
| 2017 Septiembre | 100 | 11 | 111 |
| 2017 Agosto | 103 | 17 | 120 |
| 2017 Julio | 110 | 13 | 123 |
| 2017 Junio | 112 | 39 | 151 |
| 2017 Mayo | 116 | 17 | 133 |
| 2017 Abril | 65 | 12 | 77 |
| 2017 Marzo | 42 | 27 | 69 |
| 2017 Febrero | 179 | 13 | 192 |
| 2017 Enero | 70 | 14 | 84 |
| 2016 Diciembre | 86 | 19 | 105 |
| 2016 Noviembre | 153 | 17 | 170 |
| 2016 Octubre | 142 | 18 | 160 |
| 2016 Septiembre | 224 | 16 | 240 |
| 2016 Agosto | 228 | 12 | 240 |
| 2016 Julio | 82 | 5 | 87 |
| 2016 Junio | 15 | 6 | 21 |
| 2016 Mayo | 4 | 4 | 8 |
| 2016 Abril | 6 | 6 | 12 |
| 2016 Marzo | 9 | 15 | 24 |
| 2016 Febrero | 14 | 8 | 22 |
| 2016 Enero | 10 | 1 | 11 |
| 2015 Diciembre | 11 | 3 | 14 |
| 2015 Noviembre | 7 | 0 | 7 |
| 2015 Octubre | 8 | 2 | 10 |
| 2015 Septiembre | 9 | 0 | 9 |
| 2015 Agosto | 13 | 1 | 14 |
| 2015 Julio | 116 | 4 | 120 |
| 2015 Junio | 76 | 5 | 81 |
| 2015 Mayo | 79 | 9 | 88 |
| 2015 Abril | 79 | 14 | 93 |
| 2015 Marzo | 74 | 1 | 75 |
| 2015 Febrero | 46 | 3 | 49 |
| 2015 Enero | 54 | 9 | 63 |
| 2014 Diciembre | 45 | 12 | 57 |
| 2014 Noviembre | 49 | 10 | 59 |
| 2014 Octubre | 31 | 12 | 43 |
| 2014 Septiembre | 31 | 9 | 40 |
| 2014 Agosto | 30 | 17 | 47 |
| 2014 Julio | 13 | 7 | 20 |
| 2014 Junio | 38 | 10 | 48 |
| 2014 Mayo | 24 | 6 | 30 |
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