title: Unusual presentation of thyrotoxicosis--a case report and review of literature.
abstract: BACKGROUND
  The majority of patients with thyrotoxicosis are readily diagnosed clinically. It must be accepted however that not every patient presents with the characteristic picture. Thyrotoxicosis occasionally presents in an unknown or atypical fashion in which the diagnosis may not be obvious.
  
  
  METHODS
  A 45-year-old woman presented with choreoathetoid movements of the right upper limb, persistent vomiting and generalized body weakness. Over the next few weeks, the clinical picture slowly evolved to give the characteristic symptoms and signs of thyrotoxicosis, which were not evident at presentation. Thyroid function tests revealed elevated serum thyroxine and triiodothyronine as well as low thyroid stimulating hormone concentrations, confirming the diagnosis of thyrotoxicosis.
  
  
  CONCLUSIONS
  This case illustrates unusual initial presenting features of thyrotoxicosis, which long preceded the development of the characteristic and more common manifestations. This led to a delay in the diagnosis. Awareness of these atypical presentations will further assist the physician to make a timely and cost effective diagnosis of this condition.
authors.affiliation: Department of Medicine, University College Hospital, Ibadan, Nigeria.
authors.forename: J O
authors.initials: JO
authors.lastname: Adeleye
authors.forename: R O
authors.initials: RO
authors.lastname: Akinyemi
authors.forename: W O
authors.initials: WO
authors.lastname: Balogun
authors.forename: H O
authors.initials: HO
authors.lastname: Onyegbutulem
mesh_terms: D003937:Diagnosis, Differential; D020820:Dyskinesias / Q000209:etiology; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D008787:Metoclopramide / Q000627:therapeutic use; D008875:Middle Aged; D018908:Muscle Weakness / Q000209:etiology; D013971:Thyrotoxicosis / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D034941:Upper Extremity / Q000503:physiopathology; D014839:Vomiting / Q000209:etiology
chemical_list: D008787:Metoclopramide