Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA.
Endocr Pract. 2012 Sep-Oct;18(5):e127-9. doi: 10.4158/EP11373.CR.
To report a case of apathetic thyrotoxicosis with an etiology of subacute thyroiditis.
We describe the patient's clinical findings, laboratory findings, and clinical course.
An 85-year-old woman with no history of thyroid disease presented with severe obtundation and altered mental status. Laboratory testing documented elevated free thyroxine and free triiodothyronine concentrations and a suppressed thyrotropin concentration. Thyroid antibodies were absent. A radioactive iodine study revealed severely diminished uptake, suggestive of thyroiditis. After a short course of steroids, the patient's mental status returned to baseline. Follow-up laboratory testing showed normalizing thyroid function.
Even in the absence of a history of thyroid disease, we recommend considering thyroid dysfunction in the differential diagnosis of patients who present with altered mental status, particularly in the elderly population.
报告一例亚急性甲状腺炎引起的淡漠型甲状腺毒症病例。
我们描述了患者的临床发现、实验室发现和临床经过。
一名 85 岁女性，无甲状腺疾病史，表现为严重的意识模糊和精神状态改变。实验室检查发现游离甲状腺素和游离三碘甲状腺原氨酸浓度升高，促甲状腺激素浓度受抑制。甲状腺抗体阴性。放射性碘研究显示摄取严重减少，提示甲状腺炎。短期类固醇治疗后，患者的精神状态恢复正常。随访实验室检查显示甲状腺功能正常。
即使没有甲状腺疾病史，我们也建议在诊断表现为精神状态改变的患者时，特别是在老年人群中，考虑甲状腺功能障碍的鉴别诊断。
