Thyrotoxicosis is a relatively common condition affecting 12% of women and 0.10.2% of men. Common symptoms are usually straightforward and easily identified. Rarer presenting features such as confusion and headache have been published in the literature as case reports. We hereby report two cases of Graves Thyrotoxicosis presenting unusually and therefore misleading the initial diagnostic pathway. The first case is a 45-year-old female with a 4-day history of headache which started acutely. She described a daily morning headache which improved through the day. Other symptoms were dizziness, weakness, nausea, palpitations and intermittent dyspnoea. She was noted to be in sinus tachycardia. Other examination findings were unremarkable. Thyroid Function Tests requested in view of the tachycardia showed TSH<0.01 mu/L, FT4>155 pmol/L and FT3 30.8 pmol/L. TPO antibodies were negative, but TSH Receptor antibodies were positive. The patient was safely discharged on Carbimazole 40mg OD. At 6 weeks clinic review, she complained of no headache and had TSH<0.01 mu/L and FT4 16.4 pmol/L. The second case is a 48-year-old male who presented acutely confused. He was found naked and doubly incontinent by family. He was noted to have intermittent word-finding difficulties and therefore referred to the Stroke Consultant who requested routine TFTs. A sinus tachycardia was noted. The working diagnosis was Encephalitis and the patient had CT brain and Lumbar Puncture which revealed CSF with 41 white cells (mainly Lymphocytes) and 32 red cells, with negative culture and PCR. After 2 days, the TFTs results showed undetectable TSH and FT4 48 pmol/L. TSH Receptor antibody was strongly positive. The patient was started on carbimazole 20mg OD and at 3-month review, he improved clinically and had TSH 2.09 and FT4 8.6.
19 Nov 2018 - 21 Nov 2018