scholarly journals A case of thyroid storm caused by Graves’ disease misdiagnosed as panic attack due to panic disorder

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Manabu Yasuda ◽  
Jun Kumakura ◽  
Kiyonori Oka ◽  
Kazuhito Fukuda
Keyword(s):  
Panic Disorder ◽  
Thyroid Function ◽  
Panic Attack ◽  
Thyroid Function Test ◽  
Outpatient Setting ◽  
Panic Attacks ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Sunday Morning

Abstract Background Graves’ disease is characterized by hyperthyroidism and its symptoms often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions. In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment. Case presentation We encountered a 34-year-old woman in whom thyroid crisis from Graves’ disease was misdiagnosed as panic attack. The patient was being managed as a case of panic disorder and bipolar disorder in a psychiatric outpatient setting. About 6 months before presentation she had lost about 16 kg in weight, and a month before presentation she developed several unpleasant symptoms as her condition worsened. Several weeks before she had had severe palpitations, tachycardia, and discomfort in her throat. She became unable to eat solids, ate only yogurt and gelatin, and felt it difficult to take psychiatric drugs. She visited our emergency outpatient department on a Sunday morning, presenting with nausea, severe tachycardia, fever, and restlessness with anxiety. We treated her as panic disorder with fever, but noted proptosis and considered the possibility of Graves’ disease. Thyroid function tests were performed even though data from her clinic was not available because it was a weekend. Because there was no improvement in her condition after her first visit, she returned to our hospital early the next morning. We had misdiagnosed her as having severe panic attacks due to panic disorder, and after a diazepam injection had allowed her to go home. Later that day, the thyroid function test results became available, and her symptoms and the results strongly indicated a thyroid storm. The endocrinology department was consulted immediately, and she was referred for hospitalization the next day. During hospitalization, she was treated with steroid and radioactive iodine therapy and was discharged from hospital in 3 weeks. Conclusion Psychiatrists and doctors engaged in psychosomatic medicine need to consider the possibility of severe hyperthyroidism as a differential diagnosis of panic disorder.

scholarly journals A Case of Thyroid Storm Caused by Graves' Disease Misdiagnosed as Panic Attack Due to Panic Disorder

2021 ◽  
Author(s):  
Manabu Yasuda ◽  
Jun Kumakura ◽  
Oka Kiyonori ◽  
Kazuhito Fukuda
Keyword(s):  
Panic Disorder ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Panic Attack ◽  
Panic Attacks ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Sunday Morning ◽  
Initial Examination

Abstract BackgroundGraves' disease is characterized by hyperthyroidism and the symptoms of Graves' disease often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions. In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment.Case presentationWe encountered a 34-year-old woman in whom thyroid crisis from Graves’ disease was misdiagnosed as panic attack. The patient was being managed as a case of panic disorder and bipolar disorder in a psychiatric outpatient setting. About 6 months before presentation, she had lost about 16 kg in weight, and a month before presentation, she developed several unpleasant symptoms as her condition worsened. Several weeks before, she had severe palpitations, tachycardia, and discomfort in her throat. She became unable to eat solids and ate only yogurt and gelatin and felt difficult to take psychiatric drugs.A day on the Sunday morning, she visited our department of emergency outpatient with severe nausea. Examination revealed proptosis, and so thyroid function tests were requested in addition to routine blood tests. There was no improvement in her condition, and she returned to hospital in the early hours of the next morning. Based on her symptoms, she was diagnosed as having panic attacks due to panic disorder and was given diazepam injection and allowed to go home. There was no suspicion of Graves' disease.Later that day, the thyroid function test results became available and thyroid storm was suspected. The endocrinology department was consulted immediately and she was referred and hospitalized the next day. During hospitalization, she was treated with steroid and radioisotope therapy, and was discharged from hospital in three weeks. ConclusionPsychiatrists and doctors engaged in psychosomatic medicine need to consider the possibility of thyroid disease as a differential diagnosis of panic disorder. It is necessary to check thyroid function at the initial examination when a patient presents with symptoms of severe panic attack.

scholarly journals A case of thyroid storm caused by Graves' disease misdiagnosed as panic attack due to panic disorder

2021 ◽  
Author(s):  
Manabu Yasuda ◽  
Jun Kumakura ◽  
Oka Kiyonori ◽  
Kazuhito Fukuda
Keyword(s):  
Panic Disorder ◽  
Thyroid Function ◽  
Thyroid Disease ◽  
Panic Attack ◽  
Panic Attacks ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Thyroid Function Tests ◽  
Sunday Morning ◽  
Initial Examination

Abstract Background Graves' disease is characterized by hyperthyroidism and the symptoms of Graves' disease often overlap with those of panic disorder, which may make it difficult to distinguish between the two conditions.In this report, we describe how proper diagnosis of thyroid disease in patients with mental illness can lead to appropriate treatment.Case presentation We encountered a 34-year-old woman in whom thyroid crisis from Graves’ disease was misdiagnosed as panic attack. The patient was being managed as a case of panic disorder and bipolar disorder in a psychiatric outpatient setting. About 6 months before presentation, she had lost about 16 kg in weight, and a month before presentation, she developed several unpleasant symptoms as her condition worsened. Several weeks before, she had severe palpitations, tachycardia, and discomfort in her throat. She became unable to eat solids and ate only yogurt and gelatin and felt difficult to take psychiatric drugs.A day on the Sunday morning, she visited our department of emergency outpatient with severe nausea. Examination revealed proptosis, and so thyroid function tests were requested in addition to routine blood tests. There was no improvement in her condition, and she returned to hospital in the early hours of the next morning. Based on her symptoms, she was diagnosed as having panic attacks due to panic disorder and was given diazepam injection and allowed to go home. There was no suspicion of Graves' disease.Later that day, the thyroid function test results became available and thyroid storm was suspected. The endocrinology department was consulted immediately and she was referred and hospitalized the next day. During hospitalization, she was treated with steroid and radioisotope therapy, and was discharged from hospital in three weeks. Conclusion Psychiatrists and doctors engaged in psychosomatic medicine need to consider the possibility of thyroid disease as a differential diagnosis of panic disorder. It is necessary to check thyroid function at the initial examination when a patient presents with symptoms of severe panic attack.

Neonatal thyroid storm: the importance of an accurate antenatal history

2021 ◽  
Vol 14 (1) ◽  
pp. e239278
Author(s):  
Sean Tamgumus ◽  
Elisabeth Lauesen ◽  
Michael A Boyle
Keyword(s):  
Thyroid Function ◽  
Neonatal Intensive Care ◽  
Thyroid Function Test ◽  
Term Infant ◽  
Thyroid Storm ◽  
Graves Disease ◽  
Free T4 ◽  
Post Surgery ◽  
History Of ◽  
Near Term

A near-term infant became unwell immediately after birth with cardiorespiratory compromise—persistent tachycardia, pulmonary hypertension and reduced cardiac function. There had been no concerns during the pregnancy and the obstetrical and maternal medical history was unremarkable apart from hypothyroidism. A thyroid function test on admission revealed a significantly elevated free T4 and a diagnosis of a thyroid storm was made. On questioning it became apparent that she had Graves’ disease after her last pregnancy and was rendered hypothyroid post surgery, she was not aware of the relevance of this at her booking visit. This case highlights the importance of monitoring of women who have a history of a diagnosis of Graves’ disease, regardless of thyroid function status, to allow for appropriate antenatal monitoring, preparedness of the NICU (neonatal intensive care unit) team and correct follow-up of the neonate. It also demonstrates the importance of ensuring a patient is properly educated about their condition.

scholarly journals A Rare Phenomenon of Hashimotos Thyroiditis Converting to Graves Disease

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A917-A917
Author(s):  
Ahl Jeffrey Caseja ◽  
Samer Nakhle
Keyword(s):  
Thyroid Function ◽  
Thyroid Function Test ◽  
Primary Care Providers ◽  
Deficiency Anemia ◽  
Graves Disease ◽  
Close Monitoring ◽  
Thyroid Function Tests ◽  
Care Providers ◽  
History Of

Abstract Introduction: Hashimotos thyroiditis and Graves disease are two distinct autoimmune disorders of the thyroid. Conversion of hypothyroidism to hyperthyroidism is even more rare. We report a case of an established Hashimotos thyoiditis patient who converted into Graves disease. Case Description: 67-year old female with a past medical history of iron-deficiency anemia, dyslipidemia, and depression presented with a six-month history of fatigue, cold-intolerance, hair loss, and weight gain in September of 2015. Laboratory tests confirmed diagnosis of Hashimotos thyroiditis with an elevated TSH 80.7 (0.40-4.50 mIU/L), FT4 0.2 (0.8-1.8 ng/dL), and positive thyroid antibodies TPO 24 (0.0-8.9 IU/mL). She was started on Levothyroxine 88 mcg daily. Gradually she had a decreased requirement of Levothyroxine; from February 2016 to March 2017 she maintained a normal TSH range while on 50 mcg/day with resolution of her symptoms. The patient was then lost to follow-up until she presented in the clinic in September 2018 with complaints of several weeks of easy fatigability, 10lb-weight loss, and periorbital edema. She was found to have a suppressed TSH 0.01, and elevated FT4 2.3, and FT3 8.4 (2.3-4.2 pg/mL). Her Levothyroxine 50 mcg/day was discontinued for four days and labs were repeated which still showed suppressed TSH and elevated FT4 and FT3. She was found to have a positive TRAB and a positive TSI which are consistent with hyperthyroidism. Thyroid ultrasound was performed which showed a heterogeneous thyroid gland with increased vascularity, confirming the diagnosis of Graves disease. She was started on Methimazole 10 mg daily. Her Methimazole dose was adjusted according to her thyroid function test until she had a total thyroidectomy in October 2019. She was started on levothyroxine post-operatively and as of March 2020 is on Levothyroxine 50 mcg/daily. Conclusion: Despite the rarity of Hashimotos thyroiditis converting to Graves disease, it is possible that those affected can be encountered by primary care providers and hospitalists and could easily be mistaken for over-replacement of levothyroxine. Close monitoring of the patient along with regular thyroid function tests will be required for ongoing follow-up.

scholarly journals MON-470 Biotin Masquerading as Subclinical Hyperthyroidism

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Anita Eapen ◽  
Hooman Oktaei
Keyword(s):  
Thyroid Function ◽  
Clinical Endocrinology ◽  
Thyroid Function Test ◽  
Graves Disease ◽  
Endocrine Disorders ◽  
Thyroid Function Tests ◽  
Medication History ◽  
Free T4 ◽  
Function Tests ◽  
History Of

Abstract Introduction: Thyroid conditions are among the most common endocrine disorders. Diagnosis is dependent on interpretation of laboratory tests. The challenge comes when the clinical picture is discordant with laboratory results. Case Report: Patient is a 53-year-old male with history of cardiac transplantation, type 2 diabetes mellitus, history of amiodarone-induced hyperthyroidism. He was noted to have labs indicative of hyperthyroidism, while taking amiodarone, in 2016-2017, which was treated with methimazole. He was then noted to have abnormal thyroid function tests with low TSH to 0.3 IU/L, normal T3 and normal T4 levels. Thyroid stimulating immunoglobulin had been checked multiple times, and was normal, which is inconsistent with Graves’ disease. Prior radioactive iodine uptake scan, while off amiodarone, was noted to be normal. He was also scheduled for thyroidectomy at another hospital, which was cancelled due to normalization of thyroid function tests. Consultation was received for suppressed TSH to 0.323 IU/L, without symptoms of hyperthyroidism. He had been taking biotin during this time, which he subsequently stopped taking. Repeat TSH following discontinuation of biotin, was within normal range, most recent TSH 2.48 IU/L, free T4 1.03 ng/dL, free T3 2.7 pg/mL. Discussion: Thyroid function tests are commonly ordered. Interpretation of these tests relies on the provider’s understanding of thyroid physiology in addition to interferences with medications and other conditions. High doses of biotin, which people take as supplements for multiple sclerosis, or metabolic disorders, or for healthy nails and hair, can cause thyroid function test abnormalities. Streptavidin and biotin are used in some immunoassay platforms to capture antigens (TSH, free T4) or antibodies. High levels of serum biotin can inhibit the formation of T4 antibody complex, which results in a falsely high free T4 result. Conclusion: Thyroid Function tests should be interpreted very cautiously, especially in the setting of discordant clinical findings. Prior to ordering these tests, should attempt to obtain a detailed history of medications including over-the-counter supplements, which are commonly not reported during medication history. References:Elston, Marianne S., et al. “Factitious Graves’ Disease Due to Biotin Immunoassay Interference—A Case and Review of the Literature.” The Journal of Clinical Endocrinology & Metabolism, vol. 101, no. 9, 30 June 2016, pp. 3251-3255., doi:10.1210/jc.2016-1971. Koehler, Viktoria F., et al. “Fake News? Biotin Interference in Thyroid Immunoassays.” Clinica Chimica Acta, vol. 484, 30 May 2018, pp. 320-322., doi:10.1016/j.cca.2018.05.053. Soh, Shui-Boon, and Tar-Choon Aw. “Laboratory Testing in Thyroid Conditions - Pitfalls and Clinical Utility.” Annals of Laboratory Medicine, vol. 39, no. 1, 13 Jan. 2019, pp. 3-14., doi:10.3343/alm.2019.39.1.3.

scholarly journals Coronavirus disease-19 Pandemic-Induced Panic Disorder

2021 ◽  
Vol 9 (T3) ◽  
pp. 237-239
Author(s):  
Muhammad Surya Husada ◽  
Mustafa M. Amin ◽  
Munawir Saragih
Keyword(s):  
Infectious Disease ◽  
Case Report ◽  
Panic Disorder ◽  
Panic Attack ◽  
Respiratory Symptoms ◽  
Panic Attacks ◽  
Psychosocial Burden ◽  
Her Family ◽  
Common Diagnosis ◽  
The Individual

Background: COVID-19 is a newly emerging infectious disease which is found to be caused by SARS-2. COVID-19 pandemic has spread worldwide causing a rapidly increasing number of mental disorders cases, primarily anxiety disorder. Since majority of panic disorder patients are present with great anxiety in response to their physical or respiratory symptoms, support and encouragement from psychiatrist or therapist are fundamental to alleviate the severity of the symptoms. Case Report: We reported a case of COVID-19 induced panic disorder in a woman, 52 years old, batak tribe who started to experience multiple panic attacks since one of her family members was confirmed to be Covid-10 positive. Conclusion: In general, panic disorder is a common diagnosis, but this case appeared to be interesting as it is induced by COVID-19 pandemic. As in this case, the individual who experienced multiple panic attack is not even a COVID-19 patient but has one of her family member affected by the virus. A wide body of evidence has shown that this pandemic massively contributes to worsening of psychosocial burden in nationwide.

scholarly journals The Characteristics of Children with Abnormalities Detected in Thyroid Function Tests, and Distribution of Diagnoses

2020 ◽  
Author(s):  
Elif Çelik ◽  
Ayşe Anık
Keyword(s):  
Thyroid Function ◽  
Thyroid Disease ◽  
Correct Diagnosis ◽  
Thyroid Function Test ◽  
Hashimoto Thyroiditis ◽  
Thyroid Stimulating Hormone ◽  
Thyroid Function Tests ◽  
Test Results ◽  
Function Tests ◽  
Function Test

INTRODUCTION: Thyroid function tests are among the most frequently implemented laboratory tests in primary, and secondary healthcare institutions. The aim of the present study was to investigate the demographic and clinical characteristics and final diagnosis of children referred by primary and secondary healthcare institutions with the suspicion of an abnormality in thyroid function test and/or with the initial diagnosis of specific thyroid disease. METHODS: A total of two hundred eighty-nine pediatric patients, aged between 4 and 18 years admitted to the outpatient clinics of Behçet Uz Children’s Health and Diseases Hospital between January 2018 and January 2020, were included in the study. The patient data were obtained retrospectively from the hospital records. RESULTS: A total of 66% of the patients who were included in the study were female with a median age of 12 years (8.7-14.4), while 64% of them were pubertal; and 78% of the cases were referred by secondary healthcare institutions. The most common reason for referral was isolated elevation of thyroid stimulating hormone (TSH). A total of 56% of the patients were asymptomatic at the time of admission, and thyroid function test results of 75% of them were within normal limits. When evaluated according to their final diagnoses, the children were normal/healthy (64%), diagnosed with Hashimoto thyroiditis (30%), nodular thyroid disease (3%), Graves disease (2%) and isolated increase of TSH was related to obesity in 5 patients (1%). DISCUSSION AND CONCLUSION: It is essential to evaluate children with abnormal thyroid function test results with detailed history and physical examination. Besides, the thyroid function tests should be performed with reliable and sensitive methods in standardized laboratories to reach the correct diagnosis in these children.

scholarly journals A comparative study on outcomes of preprandial versus postprandial thyroid function test

2019 ◽  
Vol 5 (6) ◽  
pp. 1662
Author(s):  
Vasim Ismail Patel ◽  
Akshay B. K.
Keyword(s):  
Thyroid Function ◽  
Subclinical Hypothyroidism ◽  
Clinical Symptoms ◽  
Thyroid Function Test ◽  
Thyroid Stimulating Hormone ◽  
Endocrine Gland ◽  
Thyroid Function Tests ◽  
Sample Collection ◽  
Free T4 ◽  
Group 2

<p class="abstract"><strong>Background:</strong> The thyroid is an<strong> </strong>endocrine gland. It secretes two hormones thyroxine (T<sub>4</sub>), triiodothyronine (T<sub>3</sub>). Hypothyroidism is a common condition encountered by a clinician. Subclinical hypothyroidism (SCH) defined as normal free thyroxine (T4) and elevated thyroid stimulating hormone (TSH), is primarily a biochemical diagnosis with or without clinical symptoms. Studies have observed that TSH levels vary at different times in a day. In practice not much importance is given to the timing of the sample collection (pre-prandial or post-prandial sate). SCH is diagnosed depending on TSH value. So the condition may be under or over diagnosed based on a single value. So we conducted this study to determine whether timing of sample collection had any significant relationship in the determination of levels of thyroid hormones.</p><p class="abstract"><strong>Methods:</strong> The study was carried on 114 patients who visited ENT department, NMCH between July 2018 and June 2019. Group-1 consisted of 38 normal patients. Group-2 consisted of 36 hypothyroidism patients GROUP-3 consisted of 40 subclinical hypothyroidism patients. Thyroid function tests (TSH and free T4) were done in fasting state and 2 hours postprandially.  </p><p class="abstract"><strong>Results:</strong> TSH values were found to be significantly lowered after food in all the three groups. Free T4 values did not show any statistically significant alteration after food.</p><p class="abstract"><strong>Conclusions:</strong> There was a significant decline in TSH values postprandially. This might lead to inappropriate diagnosis and management of patients as cases of hypothyroidism, especially in cases of sub clinical hypothyroidism.</p>

Recurrent episodes of intense fear, shortness of breath, racing heart, and sweating

2021 ◽  
pp. 111-118
Author(s):  
Christina L. Macenski
Keyword(s):  
Panic Disorder ◽  
Gold Standard ◽  
Panic Attack ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Behavioral Therapy ◽  
Panic Attacks ◽  
Shortness Of Breath ◽  
Intense Fear ◽  
Therapy Intervention ◽  
Norepinephrine Reuptake

Panic disorder consists of recurrent, unexpected panic attacks accompanied by persistent worry about future attacks and/or a maladaptive change in behavior related to the attacks. A panic attack is defined as an abrupt surge of intense fear or discomfort that reaches a peak within minutes that occurs in conjunction with several other associated symptoms such as palpitations, sweating, trembling, shortness of breath, and chest pain. Features of panic disorder that are more common in adolescents than in adults include less worry about additional panic attacks and decreased willingness to openly discuss their symptoms. All patients with suspected panic disorder should undergo a medical history, physical examination, and laboratory workup to exclude medical causes of panic attacks. Cognitive behavioral therapy (CBT) including interoceptive exposures is the gold standard therapy intervention. Medications including selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs) can also help reduce symptoms.

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