Apathetic hyperthyroidism

Introduction Apathetic hyperthyroidism is a special type of hyperthyroidism. The symptoms are opposite to those of typical hyperthyroidism, which is a form of hyperthyroidism. More common in elderly patients, insidious onset, high metabolic syndrome, eye signs, goiter is not obvious. Clinical manifestations: loss of appetite, nausea, chills, dry skin, apathy and depression, indifference to the surrounding things; mental thinking activity is slow, while answering questions is slow, sometimes attention is difficult to concentrate, lazy to speak less; palpitations are more common, Often accompanied by heart enlargement, congestive heart failure, atrial fibrillation, eyeball depression, binocular stagnation, or even drooping eyelids.

Cause

A common endocrine disease caused by excessive secretion of thyroid hormone caused by various causes. Environmental factors mainly include various factors that induce the onset of hyperthyroidism, such as trauma, mental stimulation, infection, etc. Although many hyperthyroidisms are mainly related to autoimmunity and genetic factors, but the incidence is not related to environmental factors, genetic factors are also It is important, but the genetic background and the way of inheritance are not clarified, so it is difficult to prevent it genetically.

(1) Infection: such as a cold, tonsillitis, pneumonia, etc.

(2) Trauma: such as car accidents, trauma, etc.

(3) Mental stimulation: such as mental stress, anxiety and so on.

(4) Excessive fatigue: such as overwork.

(5) Pregnancy: Hyperthyroidism may be induced or aggravated in early pregnancy.

(6) Excessive iodine intake: such as eating seaweed and other seafood.

(7) Certain drugs: such as amiodarone.

an examination

Related inspection

Urinary protein cerebrospinal fluid cyclophosphoguanamine basal metabolism basal gastric secretion erythrocyte acetylcholinesterase

Laboratory tests showed that the rate of 131I in the thyroid gland was often slightly increased when the thyroid function was hyperthyroidism. The serum protein combined with iodine or T4 increased, and the basal metabolic rate also increased.

Differential diagnosis

Differential diagnosis of "indifferent" hyperthyroidism:

The patient showed apathy, fatigue, lethargy, unresponsiveness, slow movement, obvious weight loss, dry skin, awkward face, wrinkles, and premature aging. Sometimes there are only digestive symptoms such as decreased appetite and diarrhea. Sometimes only manifested as arrhythmia (atrial fibrillation), heart rate increased slightly, rarely more than 110 times / minute, heart beat is not strong, the heart tends to increase, but also heart failure, can be combined with angina pectoris, myocardial infarction. Because the muscle weakness is obvious, the patient feels laborious to lift things and go upstairs. The thyroid gland is not swollen or mildly swollen or has nodules, generally no eyeballs are prominent, but common eyelids are drooping and eyes are dazed. It is easily misdiagnosed as a digestive tract tumor or senile depression, and even misdiagnosed as a report of hypothyroidism.

Because long-term hyperthyroidism can not be diagnosed and treated in time, it is prone to hyperthyroidism crisis. The performance of the crisis is different from that of common hyperthyroidism. The increase of body temperature pulse is not obvious, but it is not irritated, but the mental depression is indifferent. The patient quickly enters the stupor. State or coma. Laboratory tests can have the characteristics of common hyperthyroidism, but the changes in thyroid function are not significant. Clinically, older people with significant weight loss, diarrhea or tachycardia should be alert to the possibility of hyperthyroidism.

Apathetic hyperthyroidism is a hyperthyroidism, the cause of this disease is unclear, may be due to long-term failure to obtain correct diagnosis and treatment of hyperthyroidism, the body is severely consumed, or because the sympathetic nerve is not sensitive to thyroid hormone, and catecholamine depletion; Some people think that it may be related to magnesium deficiency.

Apathetic hyperthyroidism is more common in middle-aged and elderly people. The elderly are particularly common and have special clinical manifestations. The diagnosis is based on the following aspects:

1 The patient's eyeball is prominent and the sparkling light is missing. On the contrary, sometimes the eyeball is sunken, the eyes are sluggish, and even the eyelids are drooping.

2 thyroid is generally small, not easy to touch, or have nodules.

3 skin less sweat, dry, cold, wrinkled, hard, often appear stained pigmentation; facial subcutaneous fat is less accompanied by muscle atrophy.

4 neuropsychiatric symptoms: such as sputum sensation, no obvious emotional ups and downs, indifferent expression; no interest in the surrounding things, no concern; there is obvious depression, mental activity is slow; answering questions is slow, or there is a short period of inattention; There is no muscle tremor and there is a tendency to reduce movement.

5 muscle weight loss: often severe proximal myopathy, involving the shoulders, hip muscles.

6 heart: heart rate is not obvious, less than >100 times / minute, the heart tends to expand, heart failure is more common, heart beats are often not particularly powerful. Temporary or persistent atrial fibrillation, may have ventricular premature beats.

7 Evolution: The condition is more serious, prone to crisis, the patient can quickly enter the semi-arsenal state, or coma, the body temperature is not very high, the heart rate can not be too fast, not as exciting as the general hyperthyroidism crisis, may be paralyzed.

8 laboratory tests showed that the thyroid thyroid 131I rate was slightly increased when the thyroid function was hyperthyroidism, serum protein bound iodine or T4 increased, and the basal metabolic rate also increased.

In general, changes in thyroid function are not as significant as in typical hyperthyroidism patients, but they are certainly abnormal. The key to diagnosis is the clinical identification of this type.

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