A Case of Recurrent Menorrhagia Caused by Severe Hypothyroidism in a Rural Kenyan Hospital: Clues from Madarosis, Milphosis, and Woltman's Sign

Vonwicks C. Onyango, Ali J. Kariuki, Boniface Mutiso, Boniface M. Kioko, William C. Fryda
2024 · doi:10.5281/zenodo.12073500 · W6967738430
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This case report describes a patient in rural Kenya who presented with severe recurrent menorrhagia resulting from non-adherence to thyroxine replacement therapy. The authors attribute the bleeding to profound hypothyroidism, which caused anovulation leading to estrogen-induced breakthrough bleeding alongside hypocoagulation and fibrinolysis. Clinical signs such as madarosis, milphosis, and Woltman's sign supported the diagnosis, and symptoms resolved following compliant treatment. Relevance to endometriosis: listed as one of the typical gynecologic causes of abnormal uterine bleeding in the differential diagnosis discussion, though the paper's main focus is hypothyroidism.

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Abstract

Abstract: The typical causes of premenstrual abnormal uterine bleeding (e.g., menorrhagia) are gynecologic and include pregnancy-related bleeding (e.g., abortion and ectopic pregnancy), fibroids, adenomyosis, endometrial hyperplasia, cervical and uterine cancers, etc., and medical causes like coagulation disorders. Hypothyroidism must be considered a cause of menorrhagia, especially in women on thyroid hormone replacement therapy (who are non-compliant) due to its suppressive effects on ovulation with subsequent estrogen-induced breakthrough bleeding, coupled with hypocoagulation and fibrinolysis. This case study from rural Kenya highlights how non-adherence to lifelong thyroxine replacement therapy led to profound hypothyroidism with classical physical findings and caused severe recurrent menorrhagia, which subsequently resolved with compliant treatment. Keywords: menorrhagia, abnormal uterine bleeding, hypothyroidism, thyroxine, madarosis, milphosis, delayed tendon reflex, myxedema, Kenya. Title: A Case of Recurrent Menorrhagia Caused by Severe Hypothyroidism in a Rural Kenyan Hospital: Clues from Madarosis, Milphosis, and Woltman’s Sign Author: Vonwicks C. Onyango, Ali J. Kariuki, Boniface Mutiso, Boniface M. Kioko, William C. Fryda International Journal of Novel Research in Healthcare and Nursing ISSN 2394-7330 Vol. 11, Issue 2, May 2024 - August 2024 Page No: 151-156 Novelty Journals Website: www.noveltyjournals.com Published Date: 18-June-2024 DOI: https://doi.org/10.5281/zenodo.12073500 Paper Download Link (Source) https://www.noveltyjournals.com/upload/paper/A%20Case%20of%20Recurrent%20Menorrhagia-18062024-1.pdf
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Abstract

The typical causes of premenstrual abnormal uterine bleeding (e.g., menorrhagia) are gynecologic and include pregnancy-related bleeding (e.g., abortion and ectopic pregnancy), fibroids, adenomyosis, endometrial hyperplasia, cervical and uterine cancers, etc., and medical causes like coagulation disorders. Hypothyroidism must be considered a cause of menorrhagia, especially in women on thyroid hormone replacement therapy (who are non-compliant) due to its suppressive effects on ovulation with subsequent estrogen-induced breakthrough bleeding, coupled with hypocoagulation and fibrinolysis. This case study from rural Kenya highlights how non-adherence to lifelong thyroxine replacement therapy led to profound hypothyroidism with classical physical findings and caused severe recurrent menorrhagia, which subsequently resolved with compliant treatment.

Keywords

menorrhagia, abnormal uterine bleeding, hypothyroidism, thyroxine, madarosis, milphosis, delayed tendon reflex, myxedema, Kenya. Title: A Case of Recurrent Menorrhagia Caused by Severe Hypothyroidism in a Rural Kenyan Hospital: Clues from Madarosis, Milphosis, and Woltman’s Sign Author: Vonwicks C. Onyango, Ali J. Kariuki, Boniface Mutiso, Boniface M. Kioko, William C. Fryda International Journal of Novel Research in Healthcare and Nursing ISSN 2394-7330 Vol. 11, Issue 2, May 2024 - August 2024 Page No: 151-156 Novelty Journals Website: www.noveltyjournals.com Published Date: 18-June-2024 DOI: https://doi.org/10.5281/zenodo.12073500 Paper Download Link (Source) https://www.noveltyjournals.com/upload/paper/A%20Case%20of%20Recurrent%20Menorrhagia-18062024-1.pdf Files A Case of Recurrent Menorrhagia-18062024-1.pdf Files (441.6 kB) | Name | Size | Download all | |---|---|---| | md5:2fcbe2dccaf8c7bba9f6bd549ac8288d | 441.6 kB | Preview Download |

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