Management of Hyperthyroidism in Primary Care Setting

Hyperthyroidism is one the commonest endocrine diseases encountered in our daily practice. The classical features of hyperthyroidism include palpitation, tremor, heat intolerance, anxiety and weight loss despite increase in appetite. Although the clinical features are easy to recognise in most of the patients, it is important to recognise a large variety of atypical presentations. Some patients may present to gastroenterologists with symptoms such as diarrhoea and vomiting1, or to cardiologists with cardiac problems such as atrial fibrillation and congestive heart failure2. Raised alkaline phosphatase with weight loss may mislead the physicians to the suspicion of underlying malignancy or liver problem3. Thyrotoxic patients may also present with generalised weakness due to either myopathy or hypokalaemia, which leads to the suspicion of underlying neurological problem4. Hyperthyroidism may present with apathy and decreased appetite in elderly instead of common presentation of increased appetite5.