Classic Hypothyroidism case with brittle nails and hair loss

Dr Takafumi Taguchi at Kochi University, Kochi, Japan have reported a Classic Hypothyroidism case with brittle nails and hair loss. The case has appeared in NEJM Case Reports.

Hypothyroidism is especially common in women between ages 35 and 65.

Characteristic signs of hypothyroidism include: Fatigue, Cold intolerance,Appetite loss, weight gain,Cardiovascular effects like high blood pressure, elevated levels of total and LDL cholesterol, and increased homocysteine ,Mental effects including difficulty in concentrating, memory problems, and loss of interest in things ,Other signs and symptoms like Slowed metabolism reduces sweating, the skin's natural moisturizer, so the skin may become dry and flaky and nails brittle. Hair may thin or become coarse, constipation, Speech and movement may also slow down, menstrual problems and infertility.

According to the history of the case, a 41-year-old woman presented to the endocrinology clinic with nail changes that had occurred over several months and hair loss that had progressively worsened over 2 years. Her Physical examination revealed dry skin, thickened and brittle nails with horizontal ridges (Panel A), marked hair loss with coarse hair (Panel B), and a diffusely enlarged thyroid gland. There was no other finding on systemic examination.

Courtesy NEJM

The Laboratory investigations revealed a thyrotropin level of 30.5 μIU per millilitre (reference range, 0.5 to 5.0) and a serum free thyroxine level of 0.4 ng per deciliter (5.7 pmol per liter; reference range, 0.9 to 1.7 ng per deciliter [11.6 to 21.9 pmol per litre]). Further investigations showed an antithyroglobulin antibody level of 793 IU per millilitre (reference value, ≤55) and an antithyroid peroxidase antibody level of 2439 IU per millilitre (reference value, ≤9). Her Ultrasonography revealed diffuse goitre with heterogeneous internal echogenicity.

The diagnosis of the patient was Hypothyroidism due to Hashimoto’s thyroiditis. Hypothyroidism should be considered in the differential diagnosis of thickened and brittle nails and hair loss, although this extreme presentation is atypical. Five years after the initiation of levothyroxine therapy, the nail changes and hair loss had resolved (Panels C and D, respectively).

For more details click on the link: DOI: 10.1056/NEJMicm1801633