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Hypothyroidism induced by Bok Choy

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  • Hypothyroidism induced by Bok Choy

    An 88-year-old Chinese woman, who was eating large amounts of bok choy in hopes of controlling her diabetes, ended up in a coma after ‘overdosing’ on the vegetable, according to a report in the New England Journal of Medicine.

    The woman, who was not identified in the report, was brought by her family to an emergency room at a hospital in New York City last summer. She was unable to swallow or walk for three days.

    When doctors examined her, they discovered she had a severe case of hypothyroidism, which left her in a thyroid-induced coma. A breathing tube was inserted and she was taken to the intensive care unit where she eventually recovered.

    Because the woman was eating so much bok choy—between 2 to 3 pounds on a daily basis—doctors believe an enzyme in the vegetable hindered the thyroid’s ability to function properly.

    NEJM / Fox News
    Myrosinase, an enzyme in Chinese cabbage, causes the thyroid to diminish function. It is usually destroyed by cooking, but as she was ingesting large amounts of this in uncooked form, the enzyme was inhibiting thyroid function, which subsequently caused severe hypothyroidism and myxedemic coma.

    Myxedema coma is a severe form of hypothyroidism that is associated with a significant mortality rate.[24] The disorder is most often seen in patients with a history of hypothyroidism who are exposed to stressful conditions, such as surgery or extreme cold. Other events, such as concurrent cerebrovascular accidents, infections (eg, pneumonia), hypothermia, trauma, and the use of medications (eg, analgesics, sedative tranquilizer drugs, general anesthesia, narcotics, amiodarone, and lithium) can also precipitate myxedema coma.[24] The principal clinical features, in addition to the other manifestations of hypothyroidism reviewed earlier, include hypothermia, altered consciousness, delirium, hypoventilation (resulting in respiratory failure and hypercapnia), cardiac dysfunction (bradycardia, decreased cardiac output, and hypotension), constipation, and urinary retention. Periorbital edema, macroglossia, and generalized swelling may be seen. Electrolyte abnormalities, such as hyponatremia, occur in these critically ill patients, and are often due to excessive fluid retention. Elevated creatinine phosphokinase levels suggest the presence of rhabdomyolysis. Other laboratory testing abnormalities observed include hypoglycemia, dyslipidemia and anemia. The term myxedema coma may be a misnomer, since patients may have neither coma nor evidence of peripheral, nonpitting edema.[25] It is important to diagnose and treat the patient with myxedema coma aggressively because, if untreated, the disorder has a very high mortality rate. Treatment usually requires admission to a medical intensive care unit and the administration of intravenous levothyroxine.[25] Many patients also require concomitant administration of hydrocortisone until coexisting adrenal insufficiency has been excluded. Associated complications, such as infections, electrolyte disturbances, hypoglycemia, cardiorespiratory problems, hypothermia, and rhabdomyolysis, also require treatment. In spite of aggressive management, studies have suggested mortality rates between 30% and 60%, especially in the very elderly patient or those with persistent hypothermia or cardiac dysfunction.
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