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Unbound Medicine.
(apathetic hyperthyroidism)
105 results
  • Apathetic hyperthyroidism in an elderly patient presenting with psychomotor retardation. [Case Reports]
    J Am Assoc Nurse Pract. 2022 Sep 01; 34(9):1098-1102.Delacroix R, Umberger JM
  • Hyperthyroidism in the elderly population is often associated with atypical, blunted, or nonspecific signs and symptoms, also known as apathetic hyperthyroidism (AH). The absence of the classical hyperkinetic clinical presentation can be confused with the normal aging process, or other diseases, and often leads to misdiagnosis, delayed treatment, and negative outcomes for elderly patients. We pro…
  • Pathophysiology and Clinical Features of Neuropsychiatric Manifestations of Thyroid Disease. [Review]
    J Endocr Soc. 2022 Feb 01; 6(2):bvab194.Jurado-Flores M, Warda F, Mooradian A
  • Thyroid hormones (TH) have a cardinal role in the development of the central nervous system during embryogenesis and early infancy. However, the TH-responsive genes in the developing brain cease to respond to TH in adulthood. Nevertheless, thyroid dysfunction in adults is commonly associated with a host of cognitive and psychiatric problems. Cognitive decline, dysphoria, and depression are common…
  • Atrial Fibrillation as an Initial Presentation of Apathetic Thyroid Storm. [Case Reports]
    Cureus. 2021 Sep; 13(9):e17786.Ali H, Sarfraz S, … Ali H
  • Atrial fibrillation as an initial presenting symptom of an apathetic thyroid storm is under-reported, especially in the setting of undiagnosed hyperthyroidism. Very rarely, thyroid storm can present with apathetic symptoms. The author presents a case of apathetic thyrotoxicosis with atrial fibrillation. The patient had a generalized weakness, lethargy, and weight loss as initial symptoms and was …
  • [Apathetic hyperthyroidism with heart failure in an elderly patient with Plummer's disease]. [Case Reports]
    J UOEH. 2014 Dec 01; 36(4):277-83.Narisawa M, Okada Y, … Tanaka Y
  • We report a case of apathetic hyperthyroidism associated with unrecognized slowly growing functional thyroid adenoma (Plummer's disease), atrial fibrillation and heart failure. An 81-year-old woman with worsening thyroid dysfunction was admitted to our hospital for the treatment of heart failure. The patient had developed heart failure associated with chronic atrial fibrillation at 76 years of ag…
  • Apathetic thyrotoxicosis presenting with diabetes mellitus. [Case Reports]
    J Community Hosp Intern Med Perspect. 2014; 4(5):25502.Poudel RR, Belbase B, … Kafle NK
  • Apathetic form of thyrotoxicosis occurs in the elderly who can present with features of hyperglycemia, hypothyroidism, depression, or an internal malignancy. A clinical suspicion and timely diagnosis of hyperthyroidism is needed to define the correct etiology of existing problems, and to prevent grave complications. We discuss an 84-year-old woman who presented with fatigue and uncontrolled diabe…
  • A case of apathetic thyroid storm with resultant hyperthyroidism-induced hypercalcemia. [Case Reports]
    Am J Med Sci. 2013 Oct; 346(4):338-40.Parker KI, Loftley A, … Hermayer K
  • Thyroid storm is a complication of thyrotoxicosis with a 20% to 30% mortality rate characterized by hyperthermia, tachycardia and altered mental status. Rarely, thyroid storm may have an apathetic presentation. The authors present a 63-year-old woman with apathetic thyrotoxicosis and hypercalcemia. The action of thyroid hormones stimulating bone resorption more than bone formation is thought to c…
  • Thyrotoxic psychosis in an elderly woman and haloperidol use: a case report. [Case Reports]
    Psychogeriatrics. 2013 Mar; 13(1):49-51.Emul M, Sakalli A, … Ertan T
  • Thyrotoxic patients may occasionally present with affective disorders. Here, we discuss a case of a 61-year-old woman with misidentification and persecutory delusions, olfactory hallucinations, and apathy associated with thyrotoxicosis. After definitive antithyroid and antipsychotic agent haloperidol treatments, the patient was released within 4 weeks. Thyrotoxic psychosis with apathy is a rare e…
  • [Atypical presentation of an induced hyperthyroidism]. [Journal Article]
    Rev Colomb Psiquiatr. 2013 Mar; 42(1):144-50.Duque Mdel P, Miranda JB
  • We present the case of a person with baseline Bipolar Affective Disorder, who starts receiving medical treatment for subclinical Hypothyroidism, during this time the patient develops Hyperthyroidism. During the course of the latter, the patient started to exhibit depressed mood symptoms and worsening of her baseline disorder. Typically there are depressive symptoms in hypothyroidism and manic sym…
  • [Iodine and thyroid gland with or without nuclear catastrophe]. [Review]
    Med Pregl. 2012 Nov-Dec; 65(11-12):489-95.Dilas LT, Bajkin I, … Zavisić BK
  • Iodine, as a trace element, is a necessary and limiting substrate for thyroid gland hormone synthesis. It is an essential element that enables the thyroid gland to produce thyroid hormones thyroxine (T4) and triiodothyronine (T3). Synthesis of Thyroid Hormones and Iodine Metabolism. Three iodine molecules are added to make triiodothyronine, and four for thyroxine - the two key hormones produced b…
  • A clinical retrospective analysis of factors associated with apathetic hyperthyroidism. [Journal Article]
    Pathobiology. 2010; 77(1):46-51.Wu W, Sun Z, … Sun L
  • CONCLUSIONS: Greater age, increased corrected calcium levels, decreased TSH levels, increased FT(4), a decreased FT(3)/FT(4) 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.
  • A Case of Amiodarone-Induced Thyrotoxicosis: A diagnostic and therapeutic dilemma. [Journal Article]
    Sultan Qaboos Univ Med J. 2009 Dec; 9(3):319-23.Sudheer Ahamed P, Mathew A
  • Amiodarone is an iodine rich agent widely used for the treatment of ventricular arrhythmias, paroxysmal supraventricular tachycardia, atrial fibrillation and flutter. However 14-18% of patients treated with amiodarone develop overt thyroid dysfunction in the form of either amiodarone-induced thyrotoxicosis (AIT) or amiodaroneinduced hypothyroidism (AIH). Two different types of AIT have been recog…
  • Painless thyroiditis presenting as apathetic hyperthyroidism in a young male. [Case Reports]
    Mil Med. 2008 Jun; 173(6):609-11.Gaitonde DY, Kepchar J, … Sarkar M
  • 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 characte…
  • Asymptomatic hyperthyroidism in older adults: is it a distinct clinical and laboratory entity? [Review]
    Drugs Aging. 2008; 25(5):371-80.Mooradian AD
  • Hyperthyroidism is the result of increased serum free thyroid hormone levels and is associated with a well recognized set of clinical signs and symptoms. However, older patients who develop hyperthyroidism tend to have fewer hyperadrenergic signs and an increased incidence of weight loss, cardiac arrhythmias and, occasionally, apathetic mood. This article highlights the paucity of clinical signs …
  • [Some neurologic and psychiatric complications in endocrine disorders: the thyroid gland]. [Review]
    Orv Hetil. 2007 Feb 18; 148(7):303-10.Aszalós Z
  • Thyroid hormones are of primary importance for the perinatal development of the central nervous system, and for normal function of the adult brain. These hormones primarily regulate the transcription of specific target genes. They increase the cortical serotonergic neurotransmission, and play an important role in regulating central noradrenergic and GABA function. Thyroid deficiency during the pe…
  • [Atypical forms of hyperthyroidism]. [Review]
    Endokrynol Pol. 2006 Sep-Oct; 57(5):518-24.Syrenicz A, Syrenicz M, … Garanty-Bogacka B
  • Except from well-known the most frequent reasons of the hyperthyroidism such as the Graves-Basedow disease, multinodular goitre and the autonomous adenoma we should also remember the other rarer illnesses leading to the excess of thyroid hormones in the serum. Authors presented the problem of atypical forms of thyrotoxicosis which run without the overproduction of thyroid hormones and are charact…
  • [Agranulocytosis and acute coronary syndrome in apathetic hyperthyroidism]. [Case Reports]
    Srp Arh Celok Lek. 2003 May-Jun; 131(5-6):249-53.Ivović M, Radiojković B, … Drezgić M
  • CONCLUSIONS: Agranulocytosis is very rare but very serious complication of antithyroid drug therapy. It can be detected in about 0.1-1% patients during the first three months of treatment. Sudden appearance, heralded by sore throat and fever, prompt physicians to seek white blood cell and differential count [1-3]. Confirmation of diagnosis urges cessation of drug therapy and appropriate antibiotic treatment. Recently, it was reported that recombinant human granulocyte colony-stimulating factor (rhG-CSF) is to be effective in shortening the recovery time in the neutropenic patients undergoing chemotherapy and also in patients with other types of neutropenia [5]. Tamai at al. [7] confirmed positive outcome in 34 patients treated with rhG-CSF compared to corticosteroid treatment. Hematologic laboratory abnormalities disappear 7-10 days after session of therapy. Patients completely recover two to three weeks later. Fatal outcome was also described [1-5]. Thyroid hormones have profound effects on cardiovascular physiology, especially on heart rate, cardiac output and systemic vascular resistance. In patients with hyperthyroidism, cardiac output is much higher than in normal persons. This is the result of direct effect of thyroid hormones on cardiac muscle contractility, heart rate and decrease in systemic vascular resistance. Excessive thyroid hormone secretion increases cardiac Na-K-activated plasma membrane ATP-ase and sarcoplasmic reticulum Ca-activated ATP-ase with resultant in increase myocardial contractility [6, 9]. Sinus tachycardia is the most common rhythm disorder in hyperthyroidism, but paroxysmal tachycardia and atrial fibrillation are not rare. This can be explained by increased heart rate, cardiac output, blood volume, coronary artery flow and peripheral oxygen consumption in thyrotoxicosis [9]. Patients with coronary arteriosclerosis can develop angina pectoris during thyrotoxic stage, which can be explained by imbalance between cardiac demand and supply. Myocardial damage is often in thyrotoxic patients with chronic hart failure, together with myocardial infarction in patients without coronary disease [2,6]. Congestive heart failure and atrial fibrillation are relatively resistant to digitalis treatment because of high metabolic turn over of medication and excessive myocardial irritability in hyperthyroidism [6]. Cardiovascular and myopathic manifestations predominate in older hyperthyroid patients (over 60 years) and some of them can have only few symptoms of hyperthyroidism [1-3]. Thyrotoxic state characterized by fatigue, apathy, extreme weakness, low-grade fever and sometimes congestive heart failure are designated as apathetic hyperthyroidism. Such patients have small goiters, mild tachycardia and often cool and dry skin with few eye signs [6]. Patients with subclinical hyperthyroidism are at increased risk for atrial fibrillation [9]. Unstable angina and non-Q myocardial infarction (non ST elevation) are acute manifestation of coronary artery disease. The acute coronary syndrome of unstable angina, non-Q myocardial infarction and Q-wave myocardial infarction have atherosclerotic lesions of the coronary arteries as a common pathogenic substrate. Erosions or ruptures of unstable atherosclerotic plaque triggered pathophysiologic processes, resulted in thrombus formation at the site of arterial injury. This leads to abrupt reduction or cessation through the affected vessel. Clinical manifestations of unstable angina and non-Q myocardial infarction are similar and diagnosis of non-Q myocardial infarction is made on the basis of elevated serum markers indicative of cardiac necrosis, detected in peripheral circulation. Acute coronary syndrome ranging from unstable angina to myocardial infarction an non-Q myocardial infarction represents increasingly severe manifestations of the same pathophysiologic processes [10,11]. In conclusion, these 62-year-old woman presented with apathetic form of recurrent hyperthyroidism associated with two serious complications, life-threatening agranulocytosis and acute coronary syndrome.
  • Coma and thyroid storm in apathetic thyrotoxicosis. [Case Reports]
    South Med J. 2002 May; 95(5):552-4.Ghobrial MW, Ruby EB
  • We report the case of an 87-year-old woman with coma who was found to be in thyrotoxic crisis. The patient had a recent history of decreased mentation and apathy, and laboratory findings were found to be consistent with hyperthyroidism. After a stormy course, the clinical condition recovered to baseline, with return of laboratory values to normal following antithyroid therapy. We provide the deta…
  • Apathetic Graves' disease and acquired hemophilia due to factor VIIIc antibody. [Case Reports]
    J Endocrinol Invest. 2002 Mar; 25(3):246-9.Marongiu F, Cauli C, … Mariotti S
  • Acquired hemophilia due to autoantibody to Factor VIII coagulant (Factor VIIIc) is a rare event which may be observed in patients with different autoimmune diseases. To our knowledge, this association has been reported only once in patients with autoimmune thyroid disease. Here we describe a patient presenting with a severe hemorrhagic disorder due to Factor VIIIc antibody in whom biochemical scr…
  • Slowly progressive insulin-dependent diabetes mellitus in an elderly patient with Graves' disease. [Case Reports]
    Intern Med. 2000 Nov; 39(11):943-6.Saitoh T, Akamine N, … Horie T
  • We report a case of slowly progressive insulin-dependent diabetes mellitus in an elderly patient with Graves' disease. A 69-year-old man presented with apathetic thyrotoxicosis and weight loss. Laboratory findings indicated insulin-dependent diabetes mellitus (IDDM) with Graves' disease. Human leukocyte antigens DR4 and DR9, which are recognized as markers for IDDM with autoimmune thyroid disease…
  • Hyperthyroidism in elderly patients. [Journal Article]
    AORN J. 1999 Jan; 69(1):254-8.Bailes BK
  • Hyperthyroid disorders occur in older people and often are present with atypical findings or as apathetic hyperthyroidism. Hyperthyroidism exacerbates underlying chronic disease, especially cardiovascular conditions. Elderly people can be treated successfully and stabilized with careful screening, astute diagnostics, and appropriate therapy.
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