ABSTRACT
Resumen El hipertiroidismo es una patología frecuente que suele ser fácilmente reconocida por sus síntomas y signos. El hipertiroidismo apático es una forma de presentación de hipertiroidismo sin signos y síntomas característicos. Los síntomas cardinales del hipertiroidismo apático son la depresión y apatía; por ello, la ausencia de síntomas y signos clásicos retrasa el diagnóstico y el tratamiento, pues a menudo se diagnostica erróneamente como un trastorno psiquiátrico primario. Es más frecuente en pacientes de edad avanzada y es extremadamente rara en niños y adultos de mediana edad. Reportamos el caso de una mujer de mediana edad con hipertiroidismo apático caracterizado por depresión, vértigo, edema y pérdida de peso, sin otros datos clínicos de hipertiroidismo. Durante dos años recibió tratamiento por depresión, y adicionalmente fue estudiada en otras especialidades por vértigo. El diagnóstico se estableció mediante pruebas de función tiroidea y la integración con las características clínicas.
Abstract Hyperthyroidism is a common condition that is easily recognized by its signs and symptoms. The apathetic hyperthyroidism is a form of presentation of hyperthyroidism without its characteristic signs and symptoms. The cardinal symptoms of apathetic hyperthyroidism are depression and apathy. The absence of classical signs and symptoms of hyperthyroidism delays the diagnosis and treatment of the disease, as it is often misdiagnosed as a primary psychiatric disorder. It is more common in elderly patients and is extremely rare in children and middle-age adults. We report the case of a middle-age woman with apathetic hyperthyroidism characterized by depression, dizziness, edema and weight loss without other clinical data of hyperthyroidism; she had been treated for two years for major depressive disorder. She had been studied by other specialties because of vertigo. The diagnosis was made after thyroid function tests were requested, and joined with clinical findings.
ABSTRACT
A thyroid storm is a potentially fatal complication of hyperthyroidism. Early diagnosis and treatment is essential for reducing morbidity and mortality. Older patients with hyperthyroidism tend to have fewer hypermetabolic signs and increased signs of weight loss, depression, lethargy, cardiac arrhythmia, and apathetic mood. Additionally, comorbid diseases and drug history can affect thyroid function and symptoms. Here, we report an older patient with a thyroid storm and accompanied features of Parkinson's disease. She presented with generalized weakness, delirium, and anxiety. Laboratory findings were consistent with hyperthyroidism. She became drowsy with no precipitating factors. High fever, meningism, and atrial fibrilation occurred with no obvious sources. Suspecting a diagnosis of a thyroid storm, she was treated with an antithyroid drug, Lugol's solution, hydrocortisone, and supportive management. After these treatments, her clinical condition recovered and the neurological signs resolved.