Severely sustained vomiting as the main symptom in a man with thyrotoxicosis.
Thyrotoxicosis has a variety of presentations. Vomiting as a main presenting symptom of thyrotoxicosis is uncommon. We report a 40-year-old male with thyrotoxicosis who presented with sustained vomiting as the main symptom. He also had weight loss, about 10 kg over this 20-day period, and dizziness, particularly in the upright position. Esophagogastroduodenoscopy and abdominal ultrasonography were negative. Laboratory data were unremarkable except serum T4 of 21.2 microg/dl, T3 of 574 ng/dl and TSH < 0.03 microIU/ml. The patient's serum microsomal antibody was positive at a titer of 1:409,600, but serum thyroglogulin antibody was negative at a titer of less than 1:100. The symptoms improved after adminstroction of propylthyrouracil and propranol. A total of 31 such cases have been reported in English literature. The mean age of the patients was 46 +/- 14 year with a range of 19 to 68 years. Only 4 patients, including ours, were male. Weight loss was found in about half of them and might be an important clue. Thyrotoxicosis should be considered in differential diagnosis of unexplained vomiting.
Chen
Peter
P
Division of Gastroenterology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC. phc.chen@msa.hinet.net
Chen
Hua-Fen
HF
Tan
So-Wan
SW
Su
Mei-Chin
MC
Ng
Kam-Wing
KW
Jiang
Chaw-Fung
CF
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013971:Thyrotoxicosis / Q000150:complications* / Q000175:diagnosis; D014839:Vomiting / Q000209:etiology*