Comprehensive treatment and a rare presentation of Cronkhite–Canada syndrome: Two case reports and review of literature

Table 1 Results of laboratory examinations of Patients 1 and 2

Parameter	Patient 1	Patient 2	Normal range
RBC as × 1012/L	5.15	3.43	3.8-5.1/4.3–5.8
Hb in g/L	152	124	115–150/130–175
K+ in mmol/L	2.73	3.87	3.5–5.5
Na+ in mmol/L	135.6	136.3	137–147
Ca2+ in mmol/L	1.99	2.04	2.11–2.52
TP in g/L	45.9	63.5	65.0–85.0
Albumin in g/L	26.5	37.6	40.0–55.0
Routine urine	Normal	Normal
Fecal occult blood test	Positive	Positive	Negative
Fecal fat globule test	Negative	0-1
Fecal culture	Negative	Negative
ANA	Negative	Negative
T-SPOT.TB	Negative	Negative

ANA: Anti-nuclear antibody; Hb: Hemoglobin; RBC: Red blood cells; TP: Total protein; T-SPOT.TB: T-cell spot of tuberculosis test.

Table 2 Description of patients with Cronkhite–Canada syndrome combined with hypothyroidism

Ref.	Age/sex	Country	Thyroid function	Ectodermal changes	Gastrointestinal symptoms	Treatment	Outcome
Størset et al[29], 1979	66/F	Sweden	T4 36 nmol/L, TSH 45.0 μU/mL, no thyroid antibodies detected	Alopecia, onychodystrophy	Diarrhea, gastrointestinal polyposis	Thyroxine-sodium	Improved symptoms, but no changes in neurological and electromyographic findings
Jones et al[30], 1984	82/F	United States	TT4 1.0 µg/dL, TSH 31.5 mIU/ml	Alopecia, onychodystrophy, hyperpigmentation	Diarrhea, gastrointestinal polyposis	Prednisone therapy was initiated at 20 mg/d orally, tapered to 10 mg/d within 2 wk, accompanied by nutritional support	Improved
Qiao et al[9], 2005	60/F	China	T3, TSH ↑, FT4 ↓	Alopecia, nail dystrophy, hyperpigmentation	Diarrhea, intermittent abdominal pain, generalized gastrointestinal polyposis	Symptomatic treatments	Improved
Berzin et al[8], 2012	72/M	United States	TSH 1.72 mIU/L (after supplementing with levothyroxine)	Alopecia, onycholysis, and yellow nail discoloration	Diarrhea, hypogeusia, early satiety, generalized gastrointestinal polyposis	Prednisone 30 mg/d, symptomatic treatments	Died
No author[31], 2016	55/F	Korea	ND	Alopecia, onychodystrophy	Diarrhea with intermittent blood, nausea, abdominal pain, generalized gastrointestinal polyposis	Steroids and nutritional support	Improved
No author[32], 2018	56/M	United Kingdom	TSH 160 mIU/L, FT4 < 5 pmol/L	Alopecia, onychodystrophy, hyperpigmentation	Diarrhea, generalized gastrointestinal polyposis	Prednisolone	Improved
Dawra et al[33], 2018	60/M	India	TSH 94.65 µg/dL	Alopecia, onychodystrophy, hyperpigmentation	Diarrhea, anorexia, dysgeusia, multiple polyps	Cefixime, rifaximin, mesalamine, thyroid replacement, zinc supplementation (100 mg/d), along with micronutrient supplementation	Improved

F: Female; FT4: Free thyroxine 4; M: Male; ND: Not Described; T3: Thyroxine 3; T4: Thyroxine 4; TSH: Thyroid stimulating hormone.