American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2014, 2(9), 173-174
DOI: 10.12691/ajmcr-2-9-3
Open AccessCase Report

Apathetic Thyrotoxicosis Presenting with Hemoptysis

Olusegun Sheyin1, , Taiwo Falade1 and Olufemi Fasanmade1

1Department of Medicine, Lagos University Teaching Hospital, Lagos Nigeria

Pub. Date: September 08, 2014

Cite this paper:
Olusegun Sheyin, Taiwo Falade and Olufemi Fasanmade. Apathetic Thyrotoxicosis Presenting with Hemoptysis. American Journal of Medical Case Reports. 2014; 2(9):173-174. doi: 10.12691/ajmcr-2-9-3


Introduction: Apathetic thyrotoxicosis is an uncommon manifestation of hyperthyroidism. We report a case of apathetic thyrotoxicosis in an elderly Nigerian woman presenting with hemoptysis. Case Presentation: An 85 year old woman with past medical history of hypertension and euthyroid goiter presented with a two-week-history of subjective weight loss, cough, hemoptysis and progressively worsening dyspnea. Examination findings included dyspnea, pallor, goiter, an irregularly irregular pulse, tachypnea, jugular venous distension, a third heart sound and rales in both lung bases. Thyroid function tests revealed elevated free triiodothyronine and free thyroxine with a suppressed thyroid stimulating hormone. Her brain natriuretic peptide was 980pg/L and her electrocardiogram revealed atrial fibrillation with rapid ventricular response. Findings on trans-thoracic echocardiogram included a dilated left atrium, mild concentric left ventricular hypertrophy with grade 1 diastolic dysfunction, but preserved left ventricular systolic function, without any significant valvular abnormalities. A diagnosis of apathetic throtoxicosis presenting with heart failure with preserved ejection fraction, precipitated by atrial fibrillation was made and treatment was instituted. The patient reverted to sinus rhythm with resolution of her hemoptysis and heart failure symptoms within one week of admission. Discussion: Apathetic thyrotoxicosis is an atypical manifestation of hyperthyroidism more commonly found in the elderly. It presents with cardiac disease, wasting or depression with only a few of the more typical clinical manifestations of thyrotoxicosis. The hemoptysis found in our patient is most likely due to pulmonary edema from left ventricular failure. Conclusion: A diagnosis of apathetic thyrotoxicosis should be considered in the elderly patient presenting with heart failure in the absence of the usual risk factors for heart failure. Early recognition and treatment can reduce the morbidity and mortality associated with this condition.

apathetic atrial fibrillation hemoptysis hyperthyroidism thyrotoxicosis

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[1]  Leon-Sotomayor L, Christie JN Jr, Zerzan CJ Jr. Masked thyrotoxicosis. Patient presenting with recurrent hemoptysis, epistaxis and menometrorrhagia. Am J Med 1966 Sep; 41(3): 473-7.
[2]  Thomas FB, Mazzaferri EL, Skillman TG. Apathetic thyrotoxicosis: A distinctive clinical and laboratory entity. Ann Intern Med 1970; 72:679.
[3]  Trivalle C, Doucet J, Chassagne P, et al. Differences in the signs and symptoms of hyperthyroidism in older and younger patients. J Am Geriatr Soc 1996; 44:50.
[4]  Boelaert K, Torlinska B, Holder RL, Franklyn JA. Older subjects with hyperthyroidism present with a paucity of symptoms and signs: a large cross-sectional study. J Clin Endocrinol Metab 2010; 95:2715.
[5]  Klein I, Danzi S. Thyroid disease and the heart. Circulation 2007; 116:1725.
[6]  Frost L, Vestergaard P, Mosekilde L. Hyperthyroidism and risk of atrial fibrillation or flutter: a population-based study. Arch Intern Med 2004; 164:1675.
[7]  Petersen P. Thromboembolic complications in atrial fibrillation. Stroke 1990; 21:4.
[8]  Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med 2001; 344:501.
[9]  Siu CW, Yeung CY, Lau CP, et al. Incidence, clinical characteristics and outcome of congestive heart failure as the initial presentation in patients with primary hyperthyroidism. Heart 2007; 93:483.
[10]  Klein I. Endocrine disorders and cardiovascular disease. In: Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 9th, Bonow RO, Mann DL, Zipes DP, Libby P (Eds), Elsevier Saunders, Philadelphia 2012. p.1829.
[11]  Ventrella, S, Klein, I. Beta-adrenergic receptor blocking drugs in the management of hyperthyroidism. Endocrinologist 1994; 4:391.