Among the psychosyndromes least well known to be associated with an endocrinopathy is apathetic hyperthyroidism. This condition is characterized by apathy, lethargy, severe "senile depression" and often a high output cardiac failure occurring as the presenting problem.1,2,9 The depressive component of the clinical picture may occur without cardiac complications. Such depressions in the elderly, while refractory to treatment with antidepressant drugs, often respond dramatically to the correction of the underlying endocrine dysfunction.4 It is therefore important to consider "thyroid melancholia" in the differential diagnosis of such cases. Given this high index of suspicion, the diagnosis can be fairly easily made.
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