Clinical presentation (symptoms and complications) of hyperthyroidism in a cohort of 1,144 patients: results of the Thyrdel study
B. Goichot1, S. Bouée4, N. Ndaye1, P. Caron2 & F. Landron3
Symptoms and physical signs are variable and non specific in hyperthyroidism (HT). We report the results of a large study conducted among 263 French endocrinologists. Each investigator was asked to include all consecutive patients seen for HT during the study period. For each patient, symptoms, physical signs, biological data and treatment were recorded. The endocrinologists included 1,144 patients with HT: 802 Graves disease (GD), 121 multinodular goitres (MNG), 112 iatrogenic HT (mainly amiodarone), 69 toxic adenoma and 40 thyroiditis. 18.3% had subclinical HT (GD 11.0%, MNG 49.5%, iatrogenic HT 7.9%, toxic adenoma 61.4%, thyroiditis: 35.3%).
Mean age was 48.7 years (ranging from 42.7 for thyroiditis to 63.6 for MNG), 76.3% were females (78 to 83.5% for every etiology except for iatrogenic: 27.2%)
Most patients (81.9%) were diagnosed because they had clinical signs of HT except those with iatrogenic HT (mainly diagnosed by specific screening): 72.1% had palpitations, 74.5% had fatigue, 28.4% had digestive symptoms, 51.8% had thermophobia/sweating/polydipsia, 65.5% tachycardia, 16.7% had arrythmia (more frequently among iatrogenic HT: 55.4% and MNG: 24.2%), 66.5% weight loss (on average −6.3 kg), 32.2% had a clinical goiter. Symptoms were more frequent among GD, toxic adenoma and thyroiditis. Palpitations, thermophobia/sweating/polydipsia and weight loss (but not the other signs) were more frequent among patients whose TSH was below 0.1 mU/L compared to patients with 0.1<TSH<0.4 mU/L (P<0.05). Patients older than 65 years had less thermophobia/sweating/polydipsia symptoms, slower heart rate but more cardiac arythmia compared with younger subjects. More than 2/3 of patients with subclinical HT had at least one symptom of HT, they had a significantly higher heart rate but no symptom appeared discriminant with overt HT.
This large cohort study will improve our knowledge on epidemiological and clinical presentation of HT.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This work was supported, however funding details unavailable.