Apathetic Thyrotoxicosis Presenting With New-Onset Pulmonary Hypertension

Abstract

Apathetic thyrotoxicosis is a distinct clinical entity of hyperthyroidism that occurs in elderly patients. Manifestations include depression, weight loss, mild tachycardia, and symptoms of heart failure. Noteworthy is the absence of typical hyperkinetic motor symptoms. Pulmonary hypertension is an often-overlooked manifestation of thyrotoxicosis. Here, we present a case of a 67-year-old woman who presented to the clinic with complaints of dyspnea on exertion, orthopnea, leg edema, and 20-lb weight loss. Further work-up revealed pulmonary hypertension with thyrotoxicosis, without the typical sympathetic symptoms. After achieving a euthyroid state with methimazole therapy, she experienced resolution of her symptoms, and her pulmonary artery pressures normalized.