Sasikala Thallapaneni

Abstract

Internal jugular vein thrombosis (IJVT) is uncommon and an unidentifiable vascular disease which showed fatal complications mainly sepsis and pulmonary embolism. It is usually subsidiary to intravenous drug abuse, prolonged central venous catheterization or deep head-neck infections or trauma. Associated malignancies are not common and not well documented in the etiology of IJVT. Spontaneous IJVT is considered when no evident predisposing cause of thrombosis is present. A previously healthy, 37-year-old woman doctor by profession presented to the radiology department due to the mild painful swelling in the left anterior side of her neck. Physical examination revealed a painful, soft and immobile mass in the left anterior side of the neck beneath the sternocleidomastoid muscle, without hyperemia or local heat. On ultrasonographic examination, an echogenic thrombus with absent colour flow noted in left internal jugular vein s/o complete thrombosis. The patient was administered subcutaneous Fondared 7.5 mg (fondaparinux sodium inj) as anticoagulant therapy for 14 days (2 weeks). Her complaints were relieved within 14 days and later she was put on Ecosprin 150 mg once daily for 6 months. Partial recanulization was seen after 3 months. This case report describes a patient with IJVT. Venous thrombosis in general results from impaired blood flow locally or systemically that leads to activation of coagulation. Physicians should uphold a high index of suspicion in patients who present with undiagnosed swelling in the neck, or other signs and symptoms attributed to IJVT. Keywords: Spontaneous internal jugular vein thrombosis, Ultrasonography, Venous thrombosis, Coagulation.

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Abstract

Hypothyroidism resulting from a deficiency of thyroid hormones may be associated with dyslipidaemia. Since altered lipid profile is quite important in predicting CVD risk, therefore the present study aimed to investigate any possible association between the levels of certain lipid indices with thyroid profile and their diagnostic ability of cardiometabolic syndrome in patients with hypothyroidism. Material and Methods: A cohort of 40 female patients diagnosed with hypothyroidism was included as cases and thirty age and gender matched healthy females were recruited as controls. Fasting blood samples were collected for analysis of thyroid hormones, cholesterol, triglycerides and high density lipoprotein cholesterol levels by Chemiluminescence immuno-assay, and enzymatic colorimetric methods respectively. Differences in all between groups were tested using parametric independent sample T test. Pearson’s correlation or Spearman rank correlation analysis was done to study the correlations among the parameters as appropriate. Receiver operative characteristic (ROC) curve analysis was performed to study diagnostic utility of parameters. Results: Lipid indices were found to be significantly increased in patients with hypothyroidism when compared to the controls. Castelli risk index-I (CRI-I), CRI-II, atherogenic coefficient (AC) and atherogenic index of plasma (AIP), were found to be significant positively correlated with low density lipoprotein cholesterol (LDL) (r=0.923, p=0.0001, r=0.935, p=0.0001,r=0.970, p=0.0001 and r=0.382, p=0.0001 respectively). The ROC curve analysis of lipid indices for cardiometabolic risk reveals that AUC for CRI-I and AC was high and statistically significant than other lipid parameters. Conclusion: The present study suggests that in addition to routine lipid investigations the inclusion of lipid Indices especially CRI-I, AC, were better indices for screening of early detection of cardiometabolic risk in female patients with hypothyroidism. Keywords: Atherogenic index of plasma, Castelli risk index 1, Atherogenic coefficient, Cardiometabolic risk.

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