Myxedema Coma Induced by Ingestion of Raw Bok Choy

Abstract

1945benefit from both beta-blockade and ACE inhibition. However, his blood pressure was typically only 110/70 mm Hg, so only one agent could be administered, and given the frequent ventricular ectopy, his doctors elected to treat with a low dose of metoprolol succinate. Dudzinski and Schrager ask readers to keep in mind the varied presentations of polyarteritis nodosa. A more exhaustive differential diagnosis for this patient would include polyarteritis nodosa, since it can result in both renal and myocardial infarction. However, this patient had no cutaneous lesions or neuropathy, 3 had sinus bradycardia rather than tachycardia, and was found on angiography to have only "a subtle irregularity" of the midportion of the left anterior descending coronary artery; there was no evidence of aneurysms, obstruction, nodularity, dissection, or thrombosis, which would suggest polyarteritis nodosa. Moreover, since the left ventricular apical aneurysm did not appear to be consistent with a myocardial infarction, it seemed unlikely that the aneurysm was the result of vasculitis or other pathology of the coronary artery. Therefore, although the diagnosis of polyarteritis nodosa could not be formally excluded, it seemed insufficiently likely to warrant discussion, particularly in view of the limited space available in the article.

Concentrations of thiocyanate and goitrin in human plasma, their precursor concentrations in brassica vegetables, and associated potential risk for hypothyroidism

“…Excess consumption should be avoided, as an elderly woman in New York presented with myxedema coma (the most severe and a lifethreatening form of hypothyroidism) after ingesting up to 1.5 kg of raw bok choy daily for several months. 63 Animal feeding trials investigating the safety of rapeseed meal 19 typically do not distinguish the concentration of glucosinolate progoitrin, whose degradation product isothiocyanate goitrin has known antithyroid effects, from the total glucosinolate concentration of the meal. Since the glucosinolates glucoraphanin and phenethyl glucosinolate have well-established anticarcinogenic properties, this broad selection against all glucosinolates might be counterproductive.…”

Simple and rapid in vitro assay for detecting human thyroid peroxidase disruption

“…These chemical TPO inhibitors include the antithyroid drugs propylthiouracil (PTU) and methimazole (MMI), the industrial chemicals benzophenone 2 (BP2) and bisphenol A (BPA), and also foods rich in glucosinolates and flavonoids (Alexander and Zenker, 1986;Divi and Doerge, 1996;Schmutzler et al, 2007). Eating large quantities of cabbage, a source of glucosinolates, can lead to hypothyroidism and in extreme cases even coma (Chu and Seltzer, 2010;Dolan et al, 2010). Moreover, infants fed soy formulae, which are rich in flavonoids, can develop soybean goitre (Shepard et al, 1960).…”

Seizures and Cardiac Tamponade in Long-Standing Severe Hypothyroidism

“…[4][5] Environmental factors (such as low ambient temperature), infection, cerebrovascular accidents, drugs (particularly tranquilizers, anesthetics, sedatives, narcotics and lithium), and consumption of raw bok choy, may precipitate myxedema crisis. 6 In our patient, the condition resulted from long-standing untreated hypothyroidism.…”