Painless Thyroiditis Presenting as Apathetic Hyperthyroidism in a Young Male

Abstract

Apathetic hyperthyroidism is an uncommon presentation of thyrotoxicosis that is most commonly observed in elderly individuals. A small number of cases, however, have been observed in young adults-all of whom were female. We describe a case of apathetic hyperthyroidism due to painless thyroiditis in a 23-year-old active duty male, who presented with a 1-month history of change in behavior characterized by poverty of speech and disinterest in his surrounding environment. Initial evaluation for neuropsychological disorders was negative. Thyroid function tests showed a thyrotoxic state. Results of thyroid antibody testing and a thyroid uptake and scan supported the diagnosis of painless thyroiditis. The patient's presenting symptoms were attributed to apathetic thyrotoxicosis and he was treated supportively. His speech and social involvement slowly improved. Although uncommon in young adults, we recommend that apathetic hyperthyroidism be considered in the differential diagnosis of withdrawn social behavior and subsequently investigated with thyroid function tests.

Apathetic Thyroid Storm with Cardiorespiratory Failure, Pulmonary Embolism, and Coagulopathy in a Young Male with Graves’ Disease and Myopathy

“…The diagnosis of apathetic thyroid storm (thyroid storm without fever and agitation) is challenging. Though apathetic thyroid storm is a disease of elderly [ 9 ], there are occasional case reports in young adults [ 10 ] and children [ 11 ].…”

“…Though commonly associated with acute confusion [ 34 ] or agitation [ 34 ] which resolves within 2 weeks after normalization of thyroid function [ 35 ], thyroid storm might present with protracted loss of consciousness [ 35 ], psychosis [ 36 ], status epilepticus [ 37 ], extreme lethargy [ 10 ], or coma [ 38 ].…”

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.…”