Purpose Apathetic hyperthyroidism, first reported by Lahey in 1931, is a syndrome defined as absent clinical evidence of excess thyroid hormones or a hyperadrenergic state, such as palpitations, anxiety, tremor, heat intolerance, and diaphoresis, but which instead is dominated by apathy, inactivity, and, on occasion, epigastric discomfort with vomiting. It is thought to be a rare form of hyperthyroidism confined to the elderly. During August 2006, we diagnosed five cases of apathetic hyperthyroidism in middle-aged African American (AA) patients, who came to our attention because of their cardiovascular symptoms and signs.
Methods and Results During a consecutive 28-day period, we diagnosed apathetic hyperthyroidism in four AA patients (58 ± 7 years; two men, two women) who were admitted to the Cardiology Service at the Regional Medical Center and one AA outpatient (30-year-old male) referred to the Cardiology Clinic. The evaluation of these patients revealed atrial arrhythmias (two with atrial flutter/fibrillation, one of whom had received several cardioversions over the past 2 years); congestive heart failure (CHF; three patients, of whom two were repeatedly hospitalized in the recent past); or atypical chest pain that proved to be epigastric discomfort associated with persistent vomiting (two patients). Echocardiographic evidence of diastolic dysfunction was found in four patients and reduced ejection fraction (EF < 35%) in two. Serum TSH levels were suppressed (0.29 ± 0.2; normal 0.34-5.6 μIU/mL), whereas thyroxine levels (11.1 ± 2.8; normal 4.1-10.9 μg/dL) were elevated in two or at the upper end of the normal range in the remainder.
Conclusions Apathetic hyperthyroidism can occur in middle-aged AA patients who do not have hyperkinetic symptoms and signs but who present with abnormalities in cardiac rhythm, ventricular diastolic and/or systolic function, or CHF. Such cardiovascular manifestations represent pathophysiologic markers of hyperthyroidism even when thyroxine levels are not frankly above the upper end of normal and should assist, not hinder, making this diagnosis.
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