A Clinical Retrospective Analysis of Factors Associated with Apathetic Hyperthyroidism

Abstract

Objective: Apathetic hyperthyroidism can be misdiagnosed or diagnosed late, and older patients are often susceptible to adverse effects of treatment for thyrotoxicosis. The aim of this study was to identify factors associated with apathetic hyperthyroidism. Methods: We retrospectively examined serum calcium, phosphorus and bone-specific alkaline phosphatase (BAP) levels and thyroid-associated variables in 140 patients with apathetic hyperthyroidism, 456 patients with typical hyperthyroidism and 120 healthy subjects. Results: Significant differences were identified with respect to age, serum calcium and corrected calcium, serum phosphorus, thyroid-stimulating hormone (TSH), free triiodothyronine (FT₃), free thyroxine (FT₄), the FT₃/FT₄ ratio, alanine aminotransferase (ALT), aspartate aminotransferase (AST), creatinine, BAP and albumin among the typical and apathetic hyperthyroid and normal groups (all p < 0.001). Univariate logistic regression showed that age, serum calcium and corrected calcium, serum phosphorus, TSH, FT₄, FT₃/FT₄ ratio, ALT, AST and BAP were significantly associated with apathetic hyperthyroidism, and multivariate logistic regression showed that age, corrected calcium, TSH, FT₄, FT₃/FT₄ ratio, BAP and ALT were significantly associated with apathetic hyperthyroidism. Conclusion: Greater age, increased corrected calcium levels, decreased TSH levels, increased FT₄, a decreased FT₃/FT₄ ratio, increased BAP levels and increased ALT levels may be significant factors for differentiating apathetic from typical hyperthyroidism. Coordinated assessment of these variables may aid in the accurate diagnosis and treatment of this disorder.

Apathetic thyrotoxicosis presenting with diabetes mellitus

“…The etiology of the disease is unknown. Greater age, increased corrected calcium level, decreased TSH level, increased FT4, decreased FT3/FT4 ratio, increased bone-specific alkaline phosphatase, and increased ALT (alanine aminotransferase) may be significant in differentiating apathetic thyrotoxicosis from typical hyperthyroidism, which may aid in accurate diagnosis and treatment (7). Early detection and treatment can help in reducing morbidity and mortality (8).…”

Imaging surveillance for pneumothorax after CT-guided lung biopsy: Conclusions from a year of data at a tertiary care center

“…Previously reported series and cases are summarized in Table 2. [6][7][8][9][10][11][12][13][14][15][16] The exact pathogenic mechanism behind development of apathetic thyrotoxicosis is unclear. One theory suggests that the amount of catecholamines in the brain is 4 This case demonstrates a potential link between the untreated hyperthyroid state and the progression to the apathetic state.…”

A 68-Year-Old Man with Apathetic Hyperthyroidism and Lung Cancer

“…Apathetic hyperthyroidism is an uncommon condition described by Lahey FH (1931), which may evolve as heart failure or clinically undetected, easily mistaken by malignant disease [1][2][3][4][5]. The prevalence of hyperthyroidism ranges from 0.5 to 2.3% after the age of 60 years, whereas apathetic hyperthyroidism may be found in up to 15% of older people with thyrotoxicosis [5].…”

“…Apathetic hyperthyroidism is an uncommon condition described by Lahey FH (1931), which may evolve as heart failure or clinically undetected, easily mistaken by malignant disease [1][2][3][4][5]. The prevalence of hyperthyroidism ranges from 0.5 to 2.3% after the age of 60 years, whereas apathetic hyperthyroidism may be found in up to 15% of older people with thyrotoxicosis [5]. Clinical detection of hyperthyroidism in the elderly is often delayed if manifested by fatigue, weakness, weight loss, insomnia, depression, mental confusion and variable apathy [1][2][3][4][5][6].…”

“…The prevalence of hyperthyroidism ranges from 0.5 to 2.3% after the age of 60 years, whereas apathetic hyperthyroidism may be found in up to 15% of older people with thyrotoxicosis [5]. Clinical detection of hyperthyroidism in the elderly is often delayed if manifested by fatigue, weakness, weight loss, insomnia, depression, mental confusion and variable apathy [1][2][3][4][5][6]. Episodes of atrial fibrillation and heart failure in this scenery should raise the suspicion [3,4,6].…”