{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T16:03:56Z","timestamp":1789488236986,"version":"build-2803163510"},"reference-count":16,"publisher":"Department of Medicine, Warren Alpert Medical School at Brown University","issue":"4","license":[{"start":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T00:00:00Z","timestamp":1759276800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Hypothyroidism is an endocrine disorder that causes widespread systemic effects, but its impact on vascular tone is often under-recognized. We present a case of severe, longstanding hypothyroidism leading to bilateral lower extremity vasospasm and failure to thrive in a complex patient with significant psychiatric and medical comorbidities. A 46-year-old male with a history of type 2 diabetes, chronic DVT, bipolar disorder, and recent untreated hypothyroidism presented with progressive bilateral leg pain, weakness, and inability to ambulate. He had been discharged a week prior with a TSH of 101 mIU\/L and newly initiated levothyroxine 50 mcg. On return, symptoms had worsened, and his mother reported cognitive slowing. Workup revealed stable chronic DVT and new arterial duplex findings showing diffuse high-resistance waveforms consistent with vasoconstrictive physiology in both lower extremities, without stenosis. Creatinine was elevated, likely due to vasomotor nephropathy. Neurological and rheumatological causes were previously excluded. Severe hypothyroidism is known to increase systemic vascular resistance and reduce endothelial-mediated vasodilation, potentially contributing to vasospastic phenomena. In this patient, no other etiology for bilateral vasoconstriction was found. With no history of Raynaud\u2019s, vasoactive drug use, or active thrombosis, hypothyroidism remained the most plausible cause. Although rare, such vascular manifestations can lead to functional decline, especially in vulnerable patients. This case highlights the importance of considering hypothyroidism in the differential diagnosis of unexplained vasospasm and functional decline. Timely thyroid hormone replacement may reverse vascular dysfunction and prevent further complications.<\/jats:p>","DOI":"10.56305\/001c.144288","type":"journal-article","created":{"date-parts":[[2025,10,1]],"date-time":"2025-10-01T14:41:25Z","timestamp":1759329685000},"source":"Crossref","is-referenced-by-count":0,"title":["The Vasospastic Thyroid: Bilateral Leg Pain as a Vascular Manifestation of Hypothyroidism"],"prefix":"10.56305","volume":"4","author":[{"given":"Pamela","family":"Fernandes","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03dkvy735","id-type":"ROR","asserted-by":"publisher"}],"name":"New York Medical College","department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdul Allam","family":"Khan","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03dkvy735","id-type":"ROR","asserted-by":"publisher"}],"name":"New York Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aysal","family":"Mahmood","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03dkvy735","id-type":"ROR","asserted-by":"publisher"}],"name":"New York Medical College"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ameya","family":"Hodarkar","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/05gq02987","id-type":"ROR","asserted-by":"publisher"}],"name":"Brown University","department":["Department of Endocrinology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garron","family":"Lamp","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03dkvy735","id-type":"ROR","asserted-by":"publisher"}],"name":"New York Medical College","department":["Department of Internal Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"35509","published-online":{"date-parts":[[2025,10,1]]},"reference":[{"key":"ref1","article-title":"Thyrotoxicosis and myocardial infarction via coronary artery spasm: two cases with angiographic resolution after treatment"},{"key":"ref2","article-title":"Diffuse or severe coronary artery spasm in patients with hyperthyroidism","author":"Y. 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Goh","year":"2017","journal-title":"BMJ Case Rep"},{"issue":"7","key":"ref8","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1056\/NEJM200102153440707","article-title":"Thyroid hormone and the cardiovascular system","volume":"344","author":"I. Klein","year":"2001","journal-title":"N Engl J Med"},{"issue":"6","key":"ref9","doi-asserted-by":"publisher","first-page":"684","DOI":"10.1016\/0002-8703(79)90464-2","article-title":"Re-evaluation of a possible high incidence of hypertension in hypothyroid patients","volume":"98","author":"T. Endo","year":"1979","journal-title":"Am Heart J"},{"issue":"10","key":"ref10","doi-asserted-by":"publisher","first-page":"4662","DOI":"10.1210\/jc.2002-020493","article-title":"Increased central arterial stiffness in hypothyroidism","volume":"87","author":"K. Obuobie","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"issue":"1","key":"ref11","doi-asserted-by":"publisher","first-page":"M68","DOI":"10.1093\/gerona\/58.1.M68","article-title":"Increased prevalence of peripheral arterial disease in older men and women with subclinical hypothyroidism","volume":"58","author":"M. M. Mya","year":"2003","journal-title":"J Gerontol A Biol Sci Med Sci"},{"issue":"12","key":"ref12","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1002\/bjs.1800741220","article-title":"Raised serum thyrotrophin in women with peripheral arterial disease","volume":"74","author":"J. Powell","year":"1987","journal-title":"Br J Surg"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"957","DOI":"10.2147\/VHRM.S13535","article-title":"Hypothyroidism and the risk of lower extremity arterial disease","volume":"6","author":"M. A. Mazzeffi","year":"2010","journal-title":"Vasc Health Risk Manag"},{"key":"ref14","article-title":"Diffuse or severe coronary artery spasm associated with hyperthyroidism: a series of eight patients","author":"Yoon-Ho, et al. Choi","year":"2005","journal-title":"PubMed"},{"key":"ref15","article-title":"Graves' disease\u2013induced coronary artery vasospasm: RCA and LMCA ostial vasospasm relieved by intracoronary nitroglycerin"},{"key":"ref16","article-title":"Thyrotoxicosis and coronary artery spasm: case report of a 51-year-old man","year":"2010","journal-title":"Angiology"}],"container-title":["Journal of Brown Hospital Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/bhm.scholasticahq.com\/article\/144288-the-vasospastic-thyroid-bilateral-leg-pain-as-a-vascular-manifestation-of-hypothyroidism","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T15:18:35Z","timestamp":1789485515000},"score":1,"resource":{"primary":{"URL":"https:\/\/bhm.scholasticahq.com\/article\/144288-the-vasospastic-thyroid-bilateral-leg-pain-as-a-vascular-manifestation-of-hypothyroidism"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,1]]},"references-count":16,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.56305\/001c.144288","relation":{},"ISSN":["2994-5593"],"issn-type":[{"value":"2994-5593","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,1]]}}}