Related Experiment Video
Updated: May 22, 2026
04:39
Generation of a Mouse Spontaneous Autoimmune Thyroiditis Model
Published on: March 17, 2023
Apathetic thyrotoxicosis secondary to atypical subacute thyroiditis
Alessia L Carluccio1, Nina K Sundaram, Robert T Yanagisawa
1Department of Medicine, Mount Sinai School of Medicine, New York, New York 10029, USA. Alessia.Carluccio@mountsinai.org
Summary
Apathetic thyrotoxicosis, a form of hyperthyroidism, can present as altered mental status in the elderly. This case highlights subacute thyroiditis as a cause, emphasizing the need for thyroid function testing in geriatric patients with cognitive changes.
Area of Science:
- Endocrinology
- Geriatric Medicine
- Internal Medicine
Background:
- Thyrotoxicosis, or hyperthyroidism, can manifest with varied symptoms.
- Apathetic hyperthyroidism is a subtype often seen in the elderly, presenting with atypical symptoms like obtundation.
Observation:
- An 85-year-old woman presented with severe obtundation and altered mental status without a prior history of thyroid disease.
- Initial laboratory results revealed elevated free thyroxine (FT4) and free triiodothyronine (FT3) with suppressed thyrotropin (TSH).
Findings:
- Thyroid antibodies were negative, and a radioactive iodine uptake scan showed diminished uptake, suggesting thyroiditis.
- Treatment with corticosteroids led to a return to baseline mental status and normalization of thyroid function tests.
Implications:
- This case underscores the importance of considering thyroid dysfunction, specifically apathetic thyrotoxicosis secondary to subacute thyroiditis, in the differential diagnosis of altered mental status in elderly individuals.
- Early recognition and treatment can significantly improve patient outcomes and prevent misdiagnosis.
Related Concept Videos
01:24Graves Disease II: Pathophysiology
Graves’ disease is an autoimmune disorder characterized by the production of thyroid-stimulating immunoglobulins (TSI) that activate TSH receptors, leading to excessive synthesis and release of thyroid hormones (T3 and T4) and resulting in hyperthyroidism.Among all causes of hyperthyroidism, Graves’ disease is the most common and can happen at any age, though it is more frequent in women. It produces a hypermetabolic state with features such as weight loss, tachycardia, tremor, and heat...
01:25Hyperthyroidism I: Introduction
Hyperthyroidism is a type of thyrotoxicosis characterized by the thyroid gland's overproduction of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). This hormone excess increases the basal metabolic rate and enhances sensitivity to catecholamines.DiagnosisDiagnosis is based on clinical features and biochemical testing. It typically shows suppressed thyroid-stimulating hormone (TSH) levels below 0.4 mIU/L, with elevated free T3 and/or T4. Additional tests, including thyroid...
01:27Hyperthyroidism II: Pathophysiology
Hyperthyroidism is a hypermetabolic state caused by elevated levels of thyroid hormones, triiodothyronine (T3) and thyroxine (T4). It results from dysregulation at the thyroid, pituitary, or immune system level and affects multiple organ systems.PathophysiologyThe most common cause of hyperthyroidism is Graves’ disease, an autoimmune disorder in which antibodies, specifically thyroid-stimulating antibodies (TSAb), a subtype of TSH receptor antibodies (TRAb), bind to and activate TSH receptors...
01:28Graves' Disease I: Introduction
Graves' disease is an autoimmune disorder that causes hyperthyroidism, or overactivity of the thyroid gland. It results from autoantibodies called thyroid-stimulating immunoglobulins (TSIs), which bind to thyroid-stimulating hormone (TSH) receptors, leading to overstimulation of hormone production and a hypermetabolic state.EtiologyAlthough considered idiopathic, Graves’ disease has well-established contributing factors. There is a strong genetic component, with increased prevalence in...
01:23Hypothyroidism II: Pathophysiology
Hypothyroidism is a disorder characterized by insufficient production of thyroid hormones, which regulate metabolism, energy balance, and multiple organ systems.TypesHypothyroidism is classified based on the level of dysfunction. Primary hypothyroidism results from intrinsic thyroid gland dysfunction, causing reduced hormone production despite normal or increased stimulation. Secondary hypothyroidism arises from inadequate thyroid-stimulating hormone (TSH) secretion by the pituitary. Tertiary...
01:27Goiter
Goiter refers to an abnormal enlargement of the thyroid gland that may appear as a diffuse goiter (uniform enlargement) or nodular (single or multiple nodules). Functionally, it is classified as nontoxic (normal/low hormone levels) or toxic (excess hormone production).PathophysiologyDiffuse thyroid enlargement typically results from prolonged stimulation by thyroid-stimulating hormone (TSH) or TSH-like agents, commonly seen in hypothyroidism or iodine deficiency. In contrast, in hyperthyroid...