Endocrine Abstracts

Introduction: Hyperthyroidism may mimic many conditions, and there is potential for under-diagnosis if testing is considered only in patients presenting with classical symptoms.

Aim: To describe the range of presentations in patients found to have hyperthyroidism and referred from primary care.

Method: Consecutive patients diagnosed with hyperthyroidism and referred to the endocrine clinic between Jan 2009 and Nov 2009 were studied. Patients were asked to describe their reasons for seeking medical help and any symptoms at presentation using a standard questionnaire. Clinical information including diagnosis and results of investigations were recorded. ‘Typical symptoms’ were defined as those described in a standard on-line GP reference (GP Notebook).

Results: Eighty hyperthyroid patients (F:M 57:23, age 25–91) were studied. Diagnoses were Graves’ disease (58), toxic goitre (14), thyroiditis, (4) hashitoxicosis (2) and amiodarone-induced (2).

For the whole group, the most common presenting symptoms were weight loss (21%), fatigue (15%), palpitations (10%), incidental finding (9%), breathlessness (6%) and eye problems (6%). On direct questioning, weight loss, palpitation, tremor, fatigue and heat intolerance were present in nearly half of all patients.

Presentations in 47 (59%) patients were classified as typical.

In nine patients, thyroid function tests were ordered as part of routine screening (on amiodarone, well-person check, diabetes, family history); five of these were asymptomatic. Toxic nodular goitre was present in six of these patients.

In 24 patients, the main presenting symptoms were not typical of hyperthyroidism; routine thyroid tests had been performed in the work-up for non-specific complaints. The most frequent symptoms were non-specific headache (5), weight gain (4), swollen ankles (3) and vomiting (2). Other unusual presentations included anorexia, hypersomnolence, psychosis, menorrhagia, depression, ‘out of body experience’ and impotence. Hyperthyroidism was an unexpected finding in four cases presenting with other pathologies.

Conclusion: Hyperthyroidism may present in many guises and detection requires a high degree of clinical suspicion.