CLINICAL COMMUNICATION TO THE EDITOR
Vomiting and Hiccup as the First Presentation of Thyrotoxicosis To the Editor: Protean manifestations of thyrotoxicosis depend on its severity and duration, as well as the age of the patient. We describe an elderly thyrotoxic patient presenting with unusual manifestations, vomiting and hiccup, leading to a delay in diagnosis and treatment. Proposed pathogenesis and treatment are also discussed.
CASE REPORT A 76-year-old man presented with several episodes of vomiting and a 15-kg weight loss over the past 3 months. The vomiting was not related to meals and did not respond to symptomatic treatment. His symptoms worsened and were complicated with intractable hiccups. He denied diarrhea, abdominal pain, heat intolerance, or palpitation, but he noted constant fatigue. Investigation results, including gastrointestinal endoscopy, abdominal ultrasonography, and magnetic resonance imaging of the brain, were unremarkable. Examinations revealed cachexia and tachycardia. His diffusely enlarged thyroid gland was approximately twice the normal size with bruit. Other physical findings were unremarkable except for bilateral gynecomastia with mild tenderness. Graves’ disease was confirmed by elevated thyroid function tests (FT4 3.75 ng/dL, normal, 0.8-1.8; FT3 10.77 pg/mL, normal, 1.6-4.0; thyroid stimulating hormone
Vomiting and Hiccup as the First Presentation of Thyrotoxicosis To the Editor: Protean manifestations of thyrotoxicosis depend on its severity and duration, as well as the age of the patient. We describe an elderly thyrotoxic patient presenting with unusual manifestations, vomiting and hiccup, leading to a delay in diagnosis and treatment. Proposed pathogenesis and treatment are also discussed.
CASE REPORT A 76-year-old man presented with several episodes of vomiting and a 15-kg weight loss over the past 3 months. The vomiting was not related to meals and did not respond to symptomatic treatment. His symptoms worsened and were complicated with intractable hiccups. He denied diarrhea, abdominal pain, heat intolerance, or palpitation, but he noted constant fatigue. Investigation results, including gastrointestinal endoscopy, abdominal ultrasonography, and magnetic resonance imaging of the brain, were unremarkable. Examinations revealed cachexia and tachycardia. His diffusely enlarged thyroid gland was approximately twice the normal size with bruit. Other physical findings were unremarkable except for bilateral gynecomastia with mild tenderness. Graves’ disease was confirmed by elevated thyroid function tests (FT4 3.75 ng/dL, normal, 0.8-1.8; FT3 10.77 pg/mL, normal, 1.6-4.0; thyroid stimulating hormone
