Weakness, weight loss and palpitations were the main symptoms in patients diagnosed with thyrotoxicosis during hospitalization. Thyrotoxicosis should be included in the differential diagnosis when patients are admitted to the hospital with those symptoms.

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Background Worldwide aging of the population leads to an increased number of older, more complicated patients attending emergency departments (ED). Presenting symptoms of various conditions can be vague in this population, leading to delayed and potentially missed diagnoses. In the current study, we sought to characterize the demographics, final diagnoses, and outcomes of older patients who are referred to the ED for generalized weakness. METHODS We conducted a retrospective observational study in an urban tertiary hospital ED. Participants were patients aged 65 years or older who were referred to a geriatric evaluation in the ED. A total of 2,226 patients met study eligibility criteria and were enrolled between April 1, 2010 and March 31, 2013. Data on physical characteristics, discharge diagnoses, and vital status were obtained from an electronic medical database and the Ministry of the Interior. RESULTS There was no significant difference between the “weakness” and “non-weakness” groups for patients who were discharged from the ED. For admitted patients, statistically significant differences (although of no clinical significance) were noted for white blood cells (WBC) and sodium levels. Both statistically and clinically significant differences were observed for functional level. The main discharge diagnosis for admitted patients was an infection (24%), followed by "nonspecific diagnoses" (22%). Social issues as the main diagnosis were attributed to < 1% of the patients. Patients who were hospitalized for weakness were less likely to survive during the following year compared with patients hospitalized for non-weakness, but that was not the case for patients who were not admitted. CONCLUSIONS Patients admitted due to weakness were significantly more dependent on others for carrying out their daily activities. They were also more likely to die during and following hospitalization. Most of them were diagnosed during the hospitalization as having a specific medical condition.

Objectives: Hypothyroidism is usually detected in an outpatient setting, but might be diagnosed during hospitalization. The prevalent symptoms are not fully defined. This study aimed to determine the clinical characteristics of in-patients with overt hypothyroidism. Methods: The medical records of 23 inpatients (16F/7M, age 61.5 ± 21.8 years), who had 29 admissions with a primary diagnosis of hypothyroidism from January 1997 to December 2007 were retrospectively reviewed. They comprised 0.01% of all adult medical admissions during the study. Results: Fifty-five percent had a pre-admission diagnosis of hypothyroidism, 10% were nursing home residents and 38% had cognitive decline. Sixtynine percent presented with multiple complaints, mostly weakness and constipation, reported by 89% and 68%, respectively. Thyrotropin level was 74.3 ± 53.5 mIU/L (normal 0.23-4) and free thyroxine was 0.43 ± 0.29 ng/dL (normal 0.8-2). Elevated creatinine phosphokinase, anemia (hemoglobin < 12 g/dL) and hyponatremia (sodium < 135 mEq/L) were present in 89%, 62%, and 13%, respectively. Conclusions: Overt hypothyroidism during hospitalization occurs infrequently and mostly in patients with previously diagnosed hypothyroidism. Clinical manifestations include multiple non-specific symptoms, mainly weakness and constipation, while typical "hypothyroid" symptoms such as cold intolerance and weight gain are often overlooked. A high index of suspicion is needed to detect hypothyroidism in the hospital setting.