Thursday, 21 August 2003
This presentation is part of : Thursday Poster Sessions

PD-003 Apathetic Hyperthyroidism in the Elderly: A Case Report

José Eduardo Martinelli, Ivan Aprahamian, and Renata Vasconcellos Regazzini. Geriatrics and Gerontology Division, Faculdade de Medicina de Jundiaí, Jundiaí, Brazil

Introduction: Hyperthyroidism clinical presentation is similar to that seen in hypothyroidism in the elderly. They are frequently discreet and can become obscure by other existing diseases. Approximately 15% of hyperthyroidism patients are more than 60 years old. Only 25% have typical symptoms and this incidence falls with increasing age (Tibaldi et al., 1986). In 1931, Lehey showed a form of thyrotoxicosis characterized by lethargy as the main symptom, with tired and disinterested patients that did not react well to stress. They had no hyperkinetic activity. He called this presentation as apathetic hyperthyroidism, term used until now.

Case: Mrs. I.B., a 76 year old female, was set for medical assistance at Jundiai Medical School Geriatrics Outpatient Department presenting for 60 days a picture of weakness, discouragement, indisposition to activities, apathy, spending most time in bed or sited, without symptoms related to humor. Patient was diabetic with neuropathy in inferior members. The only drug been used was insulin 30U. Her blood pressure was 130x70mmHg, rhythm pulse of 82bpm, without signs of anemia or dehydration. Heart and lung sounds were normal. Good perfusion with decreased symmetric pulses and no edema in inferior members. Neurological exam showed hypopallesthesia, hyporeflexia, hypoesthesia and decreased segmental sensibility. Her TSH was 0.08ìUI/mL and free T4 was 1.83mg% diagnosing hyperthyroidism. Patient received methimazole 30mg with good evolution.

Conclusion: The first impression at clinical presentation was for hypothyroidism. But the picture of lethargy, prostration, mental slowness, and apathy with low TSH and high free T4 is compatible with apathetic hyperthyroidism. Maybe the elderly have a reduced capacity to react to elevated thyroid hormones (Lehey, 1931). The psychological aspects of hyperthyroidism are probably related to increased levels of thyroxine and its consequent alteration in central nervous system (Lishman, 1998). The value of this case report is to show a form of hyperthyroidism that can be confused with hypothyroidism or depression, in which some times, TSH level will not be verified and patient will have a wrong diagnosis.

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