{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T02:42:44Z","timestamp":1789180964388,"version":"build-2803163510"},"reference-count":21,"publisher":"The Endocrine Society","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":27,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"publisher","award":["NIHR304587"],"award-info":[{"award-number":["NIHR304587"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000272","name":"NIHR","doi-asserted-by":"publisher","award":["ACF-2023-09-004"],"award-info":[{"award-number":["ACF-2023-09-004"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Myxedema is increasingly rare in the United Kingdom, particularly among patients already on treatment. We present a case of a 13-year-old girl diagnosed with autoimmune hypothyroidism who was started on 75 \u00b5g of levothyroxine by her general practitioner. She was referred to the endocrine clinic after 6 months of treatment for hypothyroidism with 2 months of worsening fatigue, chest pain, peripheral edema, and dyspnea.<\/jats:p>\n                  <jats:p>On hospitalization, the patient\u2019s laboratory tests revealed undetectable free thyroxine level (fT4) and elevated thyrotropin (TSH) greater than 500 \u03bcIU\/mL (SI: &amp;gt;500\u2005m mIU\/L) (reference range, 0.51-4.30 \u03bcIU\/mL [SI: 0.51-4.30 mIU\/L]). She was diagnosed with thyroid myxedema and commenced intravenous (IV) hydrocortisone, IV maintenance fluids, and antibiotics.<\/jats:p>\n                  <jats:p>However, the constellation of signs and symptoms remained perplexing. Further tests revealed a large pericardial effusion, deep vein thrombosis, and nephritis. A multidisciplinary approach confirmed the diagnosis of systemic lupus erythematous (SLE), and the patient was successfully started on rituximab therapy within 5 days of admission.<\/jats:p>\n                  <jats:p>This case illustrates the importance of considering potential underlying diagnoses when assessing patients with hypothyroid crisis, especially when symptoms deviate from the typical clinical presentation. The timely recognition and management of this patient's underlying SLE were crucial in her recovery.<\/jats:p>","DOI":"10.1210\/jcemcr\/luaf309","type":"journal-article","created":{"date-parts":[[2025,12,3]],"date-time":"2025-12-03T13:07:50Z","timestamp":1764767270000},"source":"Crossref","is-referenced-by-count":1,"title":["An Unusual Presentation of Severe Hypothyroidism in a Child With Undiagnosed Systemic Lupus Erythematous"],"prefix":"10.1210","volume":"4","author":[{"given":"Josephine","family":"Elliott","sequence":"first","affiliation":[{"name":"Institute of Cancer and Genomic Sciences, University of Birmingham , Birmingham B15 2TT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman","family":"Kamaleldeen","sequence":"additional","affiliation":[{"name":"Department of Paediatric Endocrinology and Diabetes, Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham B4 6NH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Penelope","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Paediatric Rheumatology, Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham B4 6NH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5743-1077","authenticated-orcid":false,"given":"Renuka P","family":"Dias","sequence":"additional","affiliation":[{"name":"Department of Paediatric Endocrinology and Diabetes, Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham B4 6NH ,","place":["UK"]},{"name":"Department of Applied Health, School of Health Sciences, College of Medicine and Health, University of Birmingham , Birmingham B15 2TT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6435-177X","authenticated-orcid":false,"given":"Kristien","family":"Boelaert","sequence":"additional","affiliation":[{"name":"Department of Applied Health, School of Health Sciences, College of Medicine and Health, University of Birmingham , Birmingham B15 2TT ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1337-7889","authenticated-orcid":false,"given":"Zainaba","family":"Mohamed","sequence":"additional","affiliation":[{"name":"Department of Paediatric Endocrinology and Diabetes, Birmingham Women's and Children's Hospital NHS Foundation Trust , Birmingham B4 6NH ,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"issue":"S2","key":"2025122922525705000_luaf309-B1","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s12325-019-01080-8","article-title":"Hypothyroidism in context: where we\u2019ve been and where we\u2019re going","volume":"36","author":"Chiovato","year":"2019","journal-title":"Adv Ther"},{"issue":"1","key":"2025122922525705000_luaf309-B2","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1038\/s41572-022-00357-7","article-title":"Hypothyroidism","volume":"8","author":"Chaker","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"2025122922525705000_luaf309-B3","volume-title":"Myxedema","author":"Elshimy","year":"2023"},{"key":"2025122922525705000_luaf309-B4","author":"World Health Organisation"},{"issue":"1","key":"2025122922525705000_luaf309-B5","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/mrcr\/rxac057","article-title":"Atrophic autoimmune thyroiditis complicated with systemic lupus erythematosus","volume":"7","author":"Wakatsuki","year":"2023","journal-title":"Mod Rheumatol Case Rep"},{"issue":"13","key":"2025122922525705000_luaf309-B6","doi-asserted-by":"crossref","first-page":"2120","DOI":"10.1177\/0961203318805849","article-title":"Association between systematic lupus erythematosus and thyroid dysfunction: a meta-analysis","volume":"27","author":"Luo","year":"2018","journal-title":"Lupus"},{"issue":"5","key":"2025122922525705000_luaf309-B7","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/j.amjms.2025.01.006","article-title":"Thyroid hormones in systemic lupus erythematosus: the catalyst for disease progression?","volume":"369","author":"Li","year":"2025","journal-title":"Am J Med Sci"},{"issue":"5","key":"2025122922525705000_luaf309-B8","first-page":"e25355","article-title":"It's not lupus this time! 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