Intermittent Hyperthyreosis - a Heat Stress Syndrome[*]

Abstract

Intermittent hyperthyreosis occurs under various forms of stress, especially heat stress. The clinician may diagnose such cases as masked or apathetic hyperthyroidism or "formefruste" hyperthyreosis or thyroid autonomy. As most routine and standard tests may here yield inconsistent results, it is the patients' anamnesis which may provide the clue. Our Bioclimatology Unit has now seen over 100 cases in which thyroid hypersensitivity towards heat was the most prominent syndrome: 10-15% of weather-sensitive patients are affected. The patients complain before or during heat spells of such contradictory symptoms as insomnia, irritability, tension, tachycardia, palpitations, precordial pain, dyspnoe, flushes with sweating or chills, tremor, abdominal pain or diarrhea, polyuria or pollakisuria, weight loss in spite of ravenous appetite, fatigue, exhaustion, depression, adynamia, lack of concentration and confusion. Determination of urinary neurohormones allows a differential diagnosis, intermittent hyperthyreosis being characterized by three cardinal symptoms:

1. tachycardia - every case with more than 80 pulse beats being suspect (not specific);

2. urinary histamine - every case excreting more than 90 µg/day being suspect. Again the drawback of this test is its lack of specificity, as histamine may also be increased in cases of allergy and spondylitis;

3. urinary thyroxine - every case excreting more than 20 µg/day T-4 being suspect. This is the only specific test.

Therapy should make use of lithium carbonate and beta-blockers. Propyl thiouracil is rarely required.

Key words

Apathetic Hyperthyroidism - Forme Fruste - Histamine - Hyperthyreosis - Hyperthyroidism - Intermittent Hyperthyreosis - Masked Hyperthyroidism - Thyroid Autonomy

1 Supported by a grant from the Joint Research Fund of the Hebrew University and Hadassah, Jerusalem.

1 Supported by a grant from the Joint Research Fund of the Hebrew University and Hadassah, Jerusalem.