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Thyroid disease: Clinical presentation isn't what it used to be

2013; Elsevier BV; Volume: 24; Linguagem: Inglês

10.1016/j.ejim.2013.08.282

1879-0828

Patrícia Moniz, Rosa Cardiga, Miguel B. Araújo, L. Costa, Miguel Miguéns, F. Marques, Arturo Botella, Cândida Fonseca, Ana Leitão, Fátima Ceia,

Thyroid Cancer Diagnosis and Treatment

Thyroid diseases have well known, proper clinical presentations. In elderly inpatients of internal medicine wards, the clinical picture is masked by acute diseases and comorbidities, making it hard to reach the diagnosis and decisions regarding therapy. Objectives: Compare the characteristics of patients (pts) with hyper and hypothyroidism. Methods: Prospective study of patients admitted to an internal medicine ward consecutively during one year, with hyper and hypothyroidism (non-controlled clinical and subclinical forms). We compared the clinical presentation, comorbidities, season of admittance, clinical characteristics and mortality during hospital stay and upon follow-up (322 ± 227 days). Results: A total of 130 patients with thyroid dysfunction were included (prevalence: 31.6%), hypothyroidism (n = 62) vs hyperthyroidism (n = 68), age = 77.9 ± 12.6 vs 78.2 ± 14.3 years (ns); male 37.1 vs 41.2% (ns); Comorbidities in hypo versus hyperthyroidism: atrial fibrillation 48.4 vs 38.2% (ns); anemia 56.5 vs 48.5% (ns); heart failure 46.8 vs 47.1% (ns); arterial hypertension 71 vs 73.5% (ns); dementia 19.4 vs 4.4% (p = 0,008); and chronic renal disease 45.2 vs 52.9% (ns). Previous amiodarone treatment is 11.5 vs 24.2% (p = 0.062). Prevalence during winter months is (November to April) 51.6% vs 32.4% (p = 0.026). Physical exam: body mass index 27.2 ± 6.9 vs 25.8 ± 5.3 kg/m2 (ns); systolic arterial pressure 126.9 ± 29.2 vs 139.0 ± 30.3 mm Hg (p = 0,022); dyastolic arterial pressure 69.1 ± 16.2 vs 73.4 ± 19.4; and heart rate 82.5 ± 23.2 vs 87.4 ± 25 bpm (ns). Conclusion: The authors did not find the typical syndromes or clinical differences between hypo- and hyperthyroidism, except for the presence of dementia which was more frequent in pts with hypothyroidism and higher systolic arterial pressure in pts with hyperthyroidism. The prevalence of atrial fibrillation and the heart rate, contrary to what one would expect, were similar in both groups. In advanced age, the presence of multiple comorbidities and ploymedication of pts in internal medicine wards are associated with more frequent thyroid dysfunction, although with uncharacteristic presentation.