Apathetic thyrotoxicosis: A distinctive clinical and laboratory entity.
01 May 1970-Annals of Internal Medicine (American College of Physicians)-Vol. 72, Iss: 5, pp 679-685
TL;DR: Nine patients with apathetic thyrotoxicosis were studied over a 1-year period and compared with 29 typical hyperthyroid subjects, finding that these apathetic patients were significantly older and had ...
Abstract: Nine patients with apathetic thyrotoxicosis were studied over a 1-year period and compared with 29 typical hyperthyroid subjects. These apathetic patients were significantly older and had ...
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TL;DR: Thyroid storm is a dreaded, fortunately rare complication of a very common disorder and an unwavering commitment to an aggressive, multifaceted therapeutic intervention as outlined herein is critical to the obtainment of a satisfactory outcome.
594 citations
TL;DR: Depressive symptoms are associated with positive thyroid antibody status in the postpartum period as defined by the double blind comparison of the psychiatric status of women positive and negative for thyroid antibodies.
Abstract: OBJECTIVE--To define the relation between mood and autoimmune thyroid dysfunction during the eight months after delivery. DESIGN--Double blind comparison of the psychiatric status of women positive and negative for thyroid antibodies. Clinical examination and blood sampling for free triiodothyronine and thyroxine, thyroid stimulating hormone, and thyroid antibody concentrations at four weekly intervals. Psychiatric assessment at six, eight, 12, 20, and 28 weeks post partum. SETTING--Outpatient department of district hospital. PATIENTS--145 antibody positive women and 229 antibody negative women delivering between August 1987 and December 1989. MAIN OUTCOME MEASURES--Thyroid status. Number of cases of mental ill health by the general health questionnaire, research diagnostic criteria, Hamilton 17 item depression scale, hospital anxiety and depression scale, and Edinburgh postnatal depression scale. RESULTS--Six weeks after delivery the general health questionnaire showed 62 (43%) antibody positive women and 65 (28%) antibody negative women had mental ill health (chi 2 = 8.18, p less than 0.005). Follow up of 110 antibody positive and 132 antibody negative women showed significantly greater depression by research diagnostic criteria in antibody positive women (47%) than antibody negative women (32%) regardless of thyroid dysfunction. Antibody positive women showed higher mean scores for depression on the Hamilton (6.01 v 3.89, p = 0.0002), Edinburgh (7.45 v 5.92, p = 0.031), and hospital depression scales (4.95 v 3.79, p = 0.003). CONCLUSION--Depressive symptoms are associated with positive thyroid antibody status in the postpartum period.
232 citations
TL;DR: The spectrum of classic symptoms of hyperthyroidism suggests that in addition to the effects of increased thyroid hormone, affecting various organ systems, there is also a hyperadrenergic state, but direct measures of serum levels of catecholamines and their urinary metabolites demonstrate values that are equal to or less than normal.
204 citations
TL;DR: Evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity.
Abstract: Subclinical hyperthyroidism appears to be a common disorder. It may be caused by exogenous or endogenous factors: excessive TSH suppressive therapy with L-thyroxine (L-T4) for benign thyroid nodular disease, differentiated thyroid cancer, or hormone over-replacement in patients with hypothyroidism are the most frequent causes. Consistent evidence indicates that 'subclinical' hyperthyroidism reduces the quality of life, affecting both the psycho and somatic components of well-being, and produces relevant signs and symptoms of excessive thyroid hormone action, often mimicking adrenergic overactivity. Subclinical hyperthyroidism exerts many significant effects on the cardiovascular system; it is usually associated with a higher heart rate and a higher risk of supraventricular arrhythmias, and with an increased left ventricular mass, often accompanied by an impaired diastolic function and sometimes by a reduced systolic performance on effort and decreased exercise tolerance. It is well known that these abnormalities usually precede the onset of a more severe cardiovascular disease, thus potentially contributing to the increased cardiovascular morbidity and mortality observed in these patients. In addition, it is becoming increasingly apparent that subclinical hyperthyroidism may accelerate the development of osteoporosis and hence increased bone vulnerability to trauma, particularly in postmenopausal women with a pre-existing predisposition. Subclinical hyperthyroidism and its related clinical manifestations are reversible and may be prevented by timely treatment.
201 citations
TL;DR: The most prevalent diagnosis in this group of ambulatory elderly patients did not prove to be cancer, as often thought, but rather “unexplained weight loss", and CT scans were not found to be helpful as screening tests in the evaluation of weight loss.
Abstract: Significant unexplained and unintentional weight loss was found in 45 elderly patients who were identified by computer search of the diagnostic files of seven family practice centers. We performed a case series chart review study which revealed that 24% of the 45 cases had no definitive etiology for the weight loss after two years of extensive clinical investigation. Depression was found to be the most common diagnosis made (18%) followed by cancer (16%). Only four patients died during the study period and all had cancer. The most prevalent diagnosis in this group of ambulatory elderly patients did not prove to be cancer, as often though, but rather "unexplained weight loss." CT scans were not found to be helpful as screening tests in the evaluation of weight loss. Using the data from this study, the diagnostic evaluations of elderly patients with unexplained weight loss may be more efficiently directed.
159 citations
References
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TL;DR: A Thyroid storm or crisis is a severe, often fatal exacerbation of the manifestations of hyperthyroidism, which requires prompt recognition and energetic treatment if the patient...
Abstract: Excerpt INTRODUCTION Thyroid storm or crisis is a severe, often fatal exacerbation of the manifestations of hyperthyroidism, which requires prompt recognition and energetic treatment if the patient
97 citations
TL;DR: Twenty patients with 22 episodes of thyroid storm were seen between 1949 and 1969, and survival improved to 93% during the last ten years, attributed to early diagnosis and the addition of guanethidine sulfate to the existing regimen.
Abstract: Twenty patients with 22 episodes of thyroid storm were seen between 1949 and 1969. A precipitating event, most often underlying infection, could usually be identified. The protein-bound iodine level, not previously reported in a large series of patients with thyroid storm, was significantly higher (20.8ug/100 cc) than that seen in a group of patients with uncomplicated thyrotoxicosis. Hyperglycemia was observed frequently and returned to euglycemic levels with remission of thyroid storm, a fact not heretofore emphasized. The level of consciousness and degree of mentation were valuable prognostic signs with coma indicating a more serious outcome. Improving level of consciousness and mentation were seen with a favorable response to therapy. Survival improved to 93% during the last ten years. This improvement was attributed to early diagnosis and the addition of guanethidine sulfate to the existing regimen.
93 citations
78 citations
50 citations
TL;DR: In 1931-32 Lahey called attention to a clinical variety of hyperthyroidism characterized by apathy rather than hyperactivity, to which he gave the name "apathetic thyroidism".
Abstract: Excerpt In 1931-32 Lahey1, 2, 3, 4, 5called attention to a clinical variety of hyperthyroidism characterized by apathy rather than hyperactivity, to which he gave the name "apathetic thyroidism." W...
29 citations