Conundrums of hypothyroidism

Abstract

A 46 year old female came with complaints of dryness of skin and severe hair loss since 2-3 years. There was history of intermittent low grade fever, swelling all over body since 1 year; patient also complained of tingling numbness over bilateral legs and forearms along with difficulty in swallowing food. On further probing, history of difficulty in lifting arms above the head, constipation, generalised fatigue and drowsiness could be elicited. Patient also noticed raised skin coloured asymptomatic lesions over buttocks. On examination loss of eyebrows and alopecia in frontal and parietal scalp was seen. There was prominent follicular ostia and atrophy on scalp and body. Depressed keratotic papules with a generalized doughy feel of skin was appreciated all over body. A differential diagnosis of connective tissue disorder, widespread alopecia areata, folliculotropic mycosis fungoides, hypothyroidism and atopic dermatitis was made. Laboratory investigations revealed a low T3, T4 with a significantly raised TSH suggestive of a primary hypothyroidism. On histopathology mucin deposition in papillary and mid dermis was seen along with non-scarring pattern of alopecia. A diagnosis of hypothyroidism was made and patient was started on Tab. levothyroxin 75 micrograms once daily for 4 months along with hematinics, multivitamins and calcium supplements. Regular and frequent application of emollients was advised to the patient.