Reversibility of fibrotic appearance of lungs with thyroxine replacement therapy in patients with severe hypothyroidism.
OBJECTIVE
To present 2 cases of hypothyroidism with hypoxia associated with computed tomographic (CT) features suggestive of pulmonary fibrosis that resolved with correction of the hypothyroidism.


METHODS
Clinical case histories are described, comparative radiologic pulmonary images before and after treatment are provided, and the pertinent literature regarding possible pathologic mechanisms is reviewed.


RESULTS
Our first patient, a 68-year-old woman, presented with symptomatic severe hypothyroidism associated with respiratory failure. A CT scan of her lungs showed appearances suggestive of pulmonary fibrosis. Replacement therapy with levothyroxine led to correction of hypoxia and radiologic abnormalities. Our second patient, a 26-year-old man, presented with symptoms suggestive of obstructive sleep apnea that persisted despite use of positive pressure ventilation. Biochemical evaluation revealed severe hypothyroidism, and a CT scan disclosed pulmonary appearances consistent with fibrosis. His symptoms and radiologic abnormalities also improved after correction of hypothyroidism with levothyroxine therapy.


CONCLUSIONS
Radiologic pulmonary abnormalities suggestive of fibrotic disease are associated with severe hypothyroidism. Invasive investigations such as lung biopsy should be deferred until the clinical and radiologic responses to thyroxine replacement therapy have been assessed.
George
Jyothis T
JT
Centre for Diabetes and Endocrinology, York Hospital, York, United Kingdom. drjtgeorge@gmail.com
Thow
Jonathan C
JC
Rodger
Kirsty A
KA
Mannion
Richard
R
Jayagopal
Vijay
V
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008168:Lung / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D008297:Male; D011658:Pulmonary Fibrosis / Q000000981:diagnostic imaging / Q000188:drug therapy; D011859:Radiography; D013974:Thyroxine / Q000494:pharmacology* / Q000627:therapeutic use*; D016896:Treatment Outcome
D013974:Thyroxine