CC BY-NC-ND 4.0 · Laryngorhinootologie 2019; 98(S 02): S40-S41
DOI: 10.1055/s-0039-1685804
Abstracts
Learning based on Case Reports

Therapy resistant facial swelling – A case report

C Kurz
1   Universitätsklinikum Marburg, Marburg
,
R Birk
1   Universitätsklinikum Marburg, Marburg
,
BA Stuck
1   Universitätsklinikum Marburg, Marburg
› Author Affiliations
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    Introduction:

    Myxedema is an edematous swelling of the skin due to the deposition of glycosaminoglycans. The reason is a reduced degradation due to insufficient fT3 in the body. As generalized edema it occurs in hypothyroidism. Characteristic are doughy swollen eyelids, lips and tongue. Rare cardiac involvement can lead to heart failure or myxoedema coma and can be life-threatening.

    Case report:

    A female patient presented to us who was resected a few weeks ago by a residual of an oropharyngeal carcinoma of the base of the tongue (rpT3 rpN2a M0) and received an adjuvant re-radiotherapy. Upon admission, massive edema of the face, especially of the eyes and tongue, was evident. Sonography of the neck revealed a diffuse, hypoechoic, most likely edematous swelling. When suspected to have a radiogenic lymphedema, she has been receiving lymph drainage for some time, which showed no improvement. The laboratory showed a TSH level of 96 mU/l. It confirmed the suspicion of a manifest hypothyroidism, most likely induced by radiation threroiditis. It was immediately started with an L-thyroxine substitution. In the course of the treatment, the patient was resuscitated, involvement of the heart by the myxedema could not be ruled out. In the further course the patient showed a clearly regressed myxedema and a normalization of the TSH.

    Conclusion:

    Myxedema is a rare complication of hypothyroidism, but can lead to serious complications. Especially in case of refractory edema it should be considered as a differential diagnosis of lymphedema. Therefore, regular monitoring of thyroid parameters is recommended for irradiated patients.


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    Christopher Kurz
    Universitätsklinikum Marburg,
    Baldingerstraße, 35043
    Marburg

    Publication History

    Publication Date:
    12 June 2019 (online)

    © 2019. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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