case_images: PMC8570892_01
case_images: Ultrasonographic image of the gallbladder, demonstrating a thickened and hypoechoic wall, consistent with edema. The surrounding fat is hyperechoic.
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case_images: fig1
case_images: The gallbladder wall was thickened and hypoechoic, consistent with edema, and the fat surrounding the gallbladder was hyperechoic (Figure 1).
case_images: The dog in the ICU with a nasogastric tube (NGT) in place. Note the "tragic" facial expression.
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case_images: fig2
case_images: Given concern for possible myxedema coma, including hyperlipidemia, dermatologic signs consistent with an endocrinopathy, abnormal mentation, and "tragic" facial expression (Figure 2), a thyroid panel was submitted to the Michigan State University Veterinary Diagnostic Laboratory (Table 3).
case_images: Marked atherosclerotic changes of multiple organs including the (a) brain, (b) gastrointestinal tract, (c) kidney, and (d) heart.
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case_images: fig3
case_images: There was widespread atherosclerosis, grossly apparent in multiple organ systems, including the gastrointestinal tract, kidneys, heart, testes, and brain; affected arteries were firm and tortuous, thickened by friable but cohesive, yellow-tan material (Figure 3).
case_images: Histopathology of haired skin (hematoxylin and eosin stain, 10x). There is epidermal and adnexal atrophy. Dermal collagen layers are separated by white space (edema) with intervening amorphous amphophilic to basophilic material (mucinosis), changes supportive of cutaneous myxedema.
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case_images: fig4
case_images: Histologic examination of the skin revealed marked epidermal and adnexal atrophy; superficial dermal collagen fibers were separated by increased clear space containing scant amorphous amphophilic material, supportive of edema and mucinosis, respectively (Figure 4).
case_images: Histopathology of the right thyroid gland (hematoxylin and eosin stain, 10x). Histologically normal parathyroid tissue is seen in the top left. No thyroid follicular epithelium is noted (severe atrophy/loss). The tunica media of this artery is markedly expanded by foam cells, cholesterol clefts, and eosinophilic proteinaceous debris. The tunica adventitia is expanded by fibrous connective tissue, and there is mild lymphoplasmacytic infiltration within the vessel wall and extending into the adjacent fibrofatty tissue.
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case_images: fig5
case_images: Adjacent to the parathyroid glands, there was a complete paucity of thyroid epithelium/follicles (severe atrophy) with regionally extensive fibrofatty replacement and patchy lymphoplasmacytic infiltrates within the intervening connective tissue (Figure 5).
case_images: Histopathology of the liver (hematoxylin and eosin stain, 10x). There is complete loss of hepatic cord architecture with widespread biliary and periportal hepatocellular necrosis. Multifocally, hepatocytes are expanded by cytoplasmic vacuolation (hepatocellular lipidosis and/or glycogenosis).
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case_images: fig6
case_images: Hepatic changes included widespread necrotizing cholangiohepatitis, cholestasis, and hepatocellular lipidosis (Figure 6).