title: Severely sustained vomiting as the main symptom in a man with thyrotoxicosis.
abstract: 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.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Far Eastern Memorial Hospital, Taipei, Taiwan, ROC. phc.chen@msa.hinet.net
authors.forename: Peter
authors.initials: P
authors.lastname: Chen
authors.forename: Hua-Fen
authors.initials: HF
authors.lastname: Chen
authors.forename: So-Wan
authors.initials: SW
authors.lastname: Tan
authors.forename: Mei-Chin
authors.initials: MC
authors.lastname: Su
authors.forename: Kam-Wing
authors.initials: KW
authors.lastname: Ng
authors.forename: Chaw-Fung
authors.initials: CF
authors.lastname: Jiang
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013971:Thyrotoxicosis / Q000150:complications* / Q000175:diagnosis; D014839:Vomiting / Q000209:etiology*