Diagnosis in the emergency room: chronic or acute ailment? Case report
DOI:
https://doi.org/10.32385/rpmgf.v41i6.14143Keywords:
Hyperthyroidism, Sinus tachycardiaAbstract
Case description: A 23-year-old male went to the emergency room complaining of palpitations that started suddenly when resting. Mentioned similar past episodes, both when under physical exertion and when at rest, that had been previously attributed to anxiety related to agoraphobia. The subject reacted positively to initial psychiatric medication; however, at the emergency room, they denied feeling anxious. Physical examination showed bilateral exophthalmos, heart rate of 140bpm, and blood pressure of 146/105mmHg. ECG demonstrated sinus tachycardia. Blood sample analysis showed undetectable TSH and increased levels of free T4. Diagnosis was assumed to be primary hyperthyroidism de novo; the subject was given medication, cleared, and referred for an endocrinology appointment. The patient had shown episodes of tachycardia and panic attacks since 2021, with the family doctor requesting blood sample analysis, ECG, and a Holter exam, which had not been concluded.
Comments: Primary hyperthyroidism is a medical condition characterized by an increased production of thyroid hormones (thyroxine T4, and triiodothyronine T3) by the thyroid. It presents diverse symptoms such as palpitations, weight loss, irritability, low heat tolerance, hyperperspiration, and mood swings. During physical examination, patients often display tremors, tachycardia, a swollen gland, and exophthalmos. The treatment is usually a combination of anti-thyroid medicine and beta-blockers. Several studies demonstrated a positive correlation between changes in thyroid function and psychiatric conditions. As such, it is recommended to evaluate thyroid functioning in patients exhibiting psychiatric symptoms.
Downloads
References
1. Bahn RS, Burch HB, Cooper DS, Garber JR, Greenlee MC, Klein I, et al. Hyperthyroidism and other causes of thyrotoxicosis: management guidelines of the American Thyroid Association and American Association of Clinical Endocrinologists. Endocr Pract. 2011;17(3):456-520.
2. Bowen RC. Differential diagnosis of anxiety disorders. Prog Neuropsychopharmacol Biol Psychiatry. 1983;7(4-6):605-9.
3. Giovanella L. Update on diagnosis and treatment of hyperthyroidism. Q J Nucl Med Mol Imaging. 2021;65(2):89-90.
4. Kikuchi M, Komuro R, Oka H, Kidani T, Hanaoka A, Koshino Y. Relationship between anxiety and thyroid function in patients with panic disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2005;29(1):77-81.
5. Matsukawa T, Mano T, Gotoh E, Minamisawa K, Ishii M. Altered muscle sympathetic nerve activity in hyperthyroidism and hypothyroidism. J Auton Nerv Syst. 1993;42(2):171-5.
6. Orenstein H, Peskind A, Raskind MA. Thyroid disorders in female psychiatric patients with panic disorder or agoraphobia. Am J Psychiatry. 1988;145(11):1428-30.
7. Placidi GP, Boldrini M, Patronelli A, Fiore E, Chiovato L, Perugi G, et al. Prevalence of psychiatric disorders in thyroid diseased patients. Neuropsychobiology. 1998;38(4):222-5.
8. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343-421. Erratum in: Thyroid. 2025;35(9):1097.
9. Simon NM, Blacker D, Korbly NB, Sharma SG, Worthington JJ, Otto MW, et al. Hypothyroidism and hyperthyroidism in anxiety disorders revisited: new data and literature review. J Affect Disord. 2002;69(1-3):209-17.
10. Vidili G, Delitala A, Manetti R. Subclinical hyperthyroidism: the cardiovascular point of view. Eur Rev Med Pharmacol Sci. 2021;25(8):3264-71.
11. Wiersinga WM, Poppe KG, Effraimidis G. Hyperthyroidism: aetiology, pathogenesis, diagnosis, management, complications, and prognosis. Lancet Diabetes Endocrinol. 2023;11(4):282-98.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
