Hypothyroidism is a clinical syndrome due to deficiency of thyroid hormone. Thyroid hormone is responsible for maintaining the brain hemostasis and helps in central nervous system global development. There have been studies on the association of psychiatric illness with thyroid deficiency and strikingly found to be presenting feature of hypothyroidism in many patients. Literature evidence also says that underlying hypothyroidism may lead to failure of psychiatric treatment. Hence, we report a case of hypertensive patient on medications started with antidepressants and antipsychotics after being diagnosed of depression but was found to be resistant to psychiatric medications and later successfully treated with levothyroxine for underlying hypothyroidism with myxedema.

Osteoblastoma is a benign bone tumor that accounts for 10% of all spinal tumors and mostly arises from the posterior spinal elements. Isolated vertebral body osteoblastoma is relatively rare and generally requires extensive surgery. We report a rare case of L4 vertebral body osteoblastoma, which was managed successfully by computer navigation-guided transpedicular excision. A 22-year-old female presented with progressive lower back pain for the past six months. Radiological investigation revealed a sclerotic lesion involving the anterior cortex with a prominent central nidus in the anterior part of the L4 vertebral body. Based on the lesion size, a diagnosis of benign osteoblastoma (Enneking stage 2) was made, and she underwent computer navigation-assisted intralesional excision of the lesion by the bilateral transpedicular route. Histopathological examination confirmed the diagnosis of osteoblastoma. In the immediate postoperative period, the patient was completely relieved of symptoms, and the final follow-up magnetic resonance imaging showed no evidence of recurrence at the end of seven years. The intraoperative 3D navigation technology allowed a transpedicular minimal access approach to excise an osteoblastoma of the L4 vertebral body while preserving intervertebral stability and decreasing morbidity.

We describe a15-year-old girl presenting with compensatory pituitary enlargement due to primary hypothyroidism. The hyperplasia regressed following thyroxine administration. The clinical, laboratory and MRI features of the patients are described and the mechanisms of pituitary gland enlargement are discussed.

Abstract:Hypothyroidism is known to affect breathing by reducing respiratory drive. Near total narrowing of nasooropharynx and larynx due to myxedema of upper airway in an undiagnosed severe hypothyroidism is a rare phenomenon. We report a case of non goitorous severe hypothyroidism presenting with upper airway obstruction in a 60 year old male-a diagnostic challenge in acute onset airway obstruction. An upper airway myxedema and hypertrophic myopathy of pharyngeal dilator muscles in hypothyroidism can present with severe acute airway compromise in absence of goitorous enlargement of the thyroid gland.