Vomiting due to gastric stasis as the presenting feature in thyrotoxicosis

Abstract

Summary A patient with severe thyrotoxicosis of the apathetic variant in whom vomiting was the prominent presenting symptom is described. An alternative mechanism for thyrotoxic vomiting is postulated.

Nausea and Vomiting as Major Presenting Symptoms of Thyrotoxicosis

“…Tyrotoxicosis may cause hyperperistalsis resulting in a relative outlet dysfunction. Decreased gastric motility could also cause these symptoms, and has been demonstrated in two thyrotoxic patients [10,26]. Another, although unsubstantiated, possibility is that increased thyroid hormone levels have an effect on the central emetic center of the brain.…”

“…These as main presenting symptoms of thyrotoxicosis have rarely been described in the medical literature [3][4][5][6][7][8][9][10], and are usually seen as a presentation of thyrotoxic storm [12][13][14]. Thyrotoxic vomiting, however, was certainly known to earlier physicians, and Osler's Principles and Practice of Medicine [15], vividly described such a case.…”

“…Hyperthyroidism has a variety of presentations, sometimes with typical thyrotoxic symptoms lacking in prominence, and sometimes almost totally absent, particularly in the elderly [1][2][3][4][5][6][7][8][9][10]. The clinical presentation of hyperthyroidism depends on the severity of thyrotoxicosis, the duration of disease, individual susceptibility to excess thyroid hormones, and the patient's age [1].…”

“…Nausea and vomiting are poorly recognized and often are forgotten manifestations of hyperthyroidism. As major presenting symptoms of thyrotoxicosis, these manifestations have been rarely reported [3][4][5][6][7][8][9][10], and have not been included as presenting symptoms for thyrotoxicosis in standard textbooks of medicine and endocrinology [1,11]. We report three patients with nausea and vomiting as major presenting symptoms of thyrotoxicosis, where two of them were extensively investigated and thyrotoxicosis was not suspected until late in the disease.…”

A case of thyrotoxic hyperemesis

“…• The possible underlying mechanisms that have been postulated for thyrotoxic vomiting are, an increased beta adrenergic activity due to an increased number of beta adrenergic receptors 7 , decreased gastric emptying secondary to the malfunction of the pyloric sphincter 8 , and an increase in estrogen levels. 2,6 • Lack of awareness about the association between vomiting and hyperthyroidism might mislead clinicians to an alternate diagnosis and cause a marked delay in the diagnosis; 7 years in one case report.…”