Apathetic Hyperthyroidism in Middle Age

Abstract

Apathetic hyperthyroidism was first described in the medical literature by Lahey in 1931. It is a form of hyperthyroidism found principally in the elderly population. In this disorder the usual hyperkinetic presentation of thyrotoxicosis is replaced by apathy and inactivity, often leading to an erroneous psychiatric diagnosis. Although there is a paucity of literature on apathetic hyperthyroidism, it has been described in the elderly and as an extremely rare complication of hyperthyroid disorder in children. It was described only rarely in middle age. The following case highlights the diagnostic and therapeutic dilemmas encountered in a middle-aged patient who presented with dementia and apathetic hyperthyroidism.

A survey study of neuropsychiatric complaints in patients with Graves' disease

“…2 Although many of the somatic symptoms of anxiety (such as tachycardia and tremor) may be caused by increased peripheral sympathetic tone secondary to thyrotoxicosis, several studies have suggested that additional psychiatric and cognitive impairments are also seen in hyperthyroid patients. [3][4][5][6][7][8][9][10] These findings suggest a possible central effect, either due to alterations of brain thyroid hormone homeostasis or, perhaps, to autoimmune involvement in the brain.…”

“…Furthermore, although clinical endocrinologists acknowledge that psychiatric and cognitive complaints are common in patients with Graves' disease, there have been no studies addressing the possible impact of these complaints on initial diagnosis and treatment. Finally, it is unclear whether the neuropsychiatric difficulties in Graves' disease follow a course parallel to the resolution of thyrotoxicosis [5][6][7][8][9][10][11] or remain after euthyroidism has been achieved. [9][10][11][12] In this report, we present the results of a survey of the patient membership of the National Graves' Disease Foundation.…”

Thyrotoxicosis in an Elderly Patient Simulating Infectious Gastroenteritis

“…This form of hyperthyroidism is known as "Apathetic" or non-activated hyperthyroidism [4,5]. It is principally found in the elderly population and the usual hyperkinetic presentation of thyrotoxicosis is replaced by apathy and inactivity, making it difficult to diagnose [6]. Untreated hyperthyroid state increases risks of angina, heart failure and atrial fibrillation in the elderly [4].…”

Apathetic hyperthyroidism associated with thyroid storm

“…In contrast to the hyperkinetic appearance of typical hyperthyroidism, the main clinical features include apathy and inactivity. Several case reports and reviews have complemented the description of apathetic thyrotoxicosis 3–7 . However, apathy in thyroid storm has rarely been reported.…”