Apathetic thyrotoxicosis

Abstract

A 66-year-old male patient presented to the hospital with the complaints of weakness, loss of weight of about 10 kg in 2 months, decreased appetite, increased frequency of urination, not associated with burning sensation or hematuria. There was no history of fever or cough, altered bowel habits, or diabetes mellitus. Patient was suspected to harbour malignancy, underwent upper gastrointestinal endoscopy (UGI), high resolution computed tomography (HRCT) chest in an outside hospital which were normal. Patient came to this hospital for CT scan of abdomen. Patient was examined thoroughly and the clinically positive findings were, generalised wasting, tremors in the hands, heart rate 110 per min which led to investigate in lines of thyrotoxicosis. Thyroid stimulating hormone (TSH) was 0.01 free T3 was high and all other investigations normal. Random blood Sugar 115mg %, prostate-specific antigen 2.5ng/ml. patient underwent tc99 scan which was suggestive of were Graves’ disease. Endocrinology department has taken the patient and started on neomercazole, proponolol and discharged. Keywords: apathetic thyrotoxicosis; hyperthyroidism; weight loss; thyroid hormone

Apathetic hyperthyroidism in an elderly patient presenting with psychomotor retardation

“…The pathophysiology of “inflammaging” is multifactorial and results from the overstimulation of the innate immune system and chronic elevation of inflammatory markers without evidence of infection (Fulop et al, 2021). Additionally, normal, age-related changes leading to decrease circulating amines, alteration of the thyroid physiology, and pituitary sensitivity, all of which mitigate the classic symptomatology of hyperthyroidism (Jasim & Gharib, 2018; Solanki et al, 2018; Srinivas & Sravan Kumar, 2015). Moreover, Wu et al (2010) reports that normal aging changes in the autonomic nervous system, decreased physiologic reserve, and decreased adrenergic tone, contribute to the increased prevalence of AH among the elderly.…”

“…Primary hyperthyroidism in any age group is the result of an increased hormone synthesis and secretion from the thyroid gland and a suppressed thyrotropin level. The classical hyperkinetic signs and symptoms associated with hyperthyroidism are often absent among the elderly population (Srinivas & Sravan Kumar, 2015). Therefore, it warrants a high degree of suspicion among clinicians if patients present with signs and symptoms, listed in Table 1, and the initiation of appropriate laboratory studies.…”

“…Moreover, Wu et al (2010) reports that normal aging changes in the autonomic nervous system, decreased physiologic Table 1. Hyperthyroidism: comparative profiles among patient 60 years or older (Fischbach & Fischbach, 2018;Franceschi et al, 2019;Jasim & Gharib, 2018;Solanki et al, 2018;Srinivas & Sravan Kumar, 2015;Wu et al, 2010) reserve, and decreased adrenergic tone, contribute to the increased prevalence of AH among the elderly. Hence, it is fair to say that a combination of factors contributes to endocrine disruptors and an asymptomatic or atypical presentation of hyperthyroidism in the elderly.…”

“…In 1931, Dr. Frank Lahey first coined the current term “apathetic hyperthyroidism”, which described more accurately the atypical clinical presentations of extreme fatigue, general weakness, depressive features, mental confusion, psychomotor retardation, unintentional weight loss, tachycardia often accompanied by arrhythmias, and heart failure. The end-stage presentation is a severe apathetic state and often mistakenly diagnosed as a primary psychiatric disorder (Srinivas & Sravan Kumar, 2015; Solanki et al, 2018).…”

“…Hyperthyroidism: comparative profiles among patient 60 years or older(Fischbach & Fischbach, 2018;Franceschi et al, 2019;Jasim & Gharib, 2018;Solanki et al, 2018;Srinivas & Sravan Kumar, 2015;Wu et al, 2010), continued…”