Ladies and gentlemen, I present the “warm room” sign.
Last month I saw a woman in her sixties who had come for her annual hypertension review. As she walked in she mentioned that my room was cooler than the waiting room, and said “that's nice”. I didn't think anything of it at first, but while checking her blood pressure I noticed that her heart was beating rapidly and her pulse was 108. This was particularly unusual because one of her drugs was a beta-blocker which would tend to slow the heart. I was starting to suspect that she might have an over-active thyroid, and in response to my questions she told me that she had noticed her hands trembling a little and had lost a little weight. I sent off blood tests which duly confirmed that she has hyperthyroidism.
A little later in the month I saw a woman in her fifties who complained mainly of aching shoulders, but had also lost some weight. She also mentioned that my consulting room was too hot. When I examined her I found her pulse was slightly raised at 92 and she also had a slight tremor. Blood tests have now confirmed that she also has hyperthyroidism, though not as severe as that of the first woman.
I like my room to be comfortably warm, not too hot and not too cold, and go to some trouble to make it so. Patients who complain about the temperature may therefore have a problem with their thyroid. It's certainly worth considering.
18 comments:
Can hyperthyroidism cause acheing shoulders? Or was that due to something else?
I don't know. She is a bit young for polymyalgia, but I checked her ESR and CRP and they were normal. We'll have to wait and see whether her shoulder ache and weight loss improve with treatment.
Fuddled Medic
Hyperthyroidism can cause frozen shoulder. See for example...
http://www.ncbi.nlm.nih.gov/pubmed/3498494
Thyroid hormone imbalance can cause myopathies....
http://emedicine.medscape.com/article/1170469-overview
Dr Brown, does the room temperature test apply in reverse? Eg. if a patient complains that your room is bitterly cold, would you test for hypothyroidism?
How can you think of retiring?
Just a comment: the symptoms I had ticked all the (clinical history)boxes for PMR (I could hardly move in the morning and the pain was quite excruciating at times) except it started when I was about 52 so the consultant said I was too young and anyway there were no abnormal blood values. At 57 I have an ESR of 4 (yes, 4, I didn't miss out another figure) and the CRP is also normal. Within 24 hours of starting 15mg prednisolone almost all symptoms had resolved and I could comb my hair and walk up stairs again. Within 24 hours of stopping the steroids (down to 5mg) they were back. Two GPs (one in England and one in Italy) are quite satisfied I fill the PMR criteria - the consultant still says it's a strange inflammatory arthritis and wants to use sulphasalazine.
I'm sticking with the GPs and am doing brilliantly at 7mg and falling at present (although the symptoms are very weather dependent, by the way). Just thought I'd chuck it in for consideration! It's better to be pain-free than thought too young for something, nice though being too young might be!
Or they're pregnant.
My hands are like icicles even on the best of days. When I'm doing Leopold's, I usually apologize in advance for my cold hands and tend to get the response: "No problem, that actually feels nice!"
Nice blog! I will stop by again.
Interesting post Dr. Brown! Much as I hate to burst your bubble, one of my textbooks suggested the same thing so unfortunately you aren't the first to have noticed this phenomenon...
Thanks everyone. Thyroid disease can cause weird symptoms and TFTs are worth checking whenever you are in doubt. We had a patient who presented with bizarre incapacitating symptoms but nothing to suggest hypothyroidism, but was profoundly hypothyroid.
Eileen: that's interesting. It shows that you have to treat the patient not the lab results, and that diseases don't always follow the textbooks. Let's hope that doctors continue to think independently, despite all the guidelines.
XE: I wasn't claiming this as an original observation. But I hope you are pleased to hear that what you read in textbooks occasionally happens in real life. :-)
While people may have different views still good things should always be appreciated. Yours is a nice blog. Liked it!!!
Yes its a bit problem for them who has hyperthyroidism. Because I have also high blood pressure. And too hot and too cold actually effects on us those who has hyperthyroidism.
They might be taking different medicines other than doctors prescription.
who knew that the doctors waiting room diagnose patients before they where seen thanks for sharing and i enjoy the other posts on your blog
Dear Doctor,
Could you give me an e-mail to contact you?
Thank you very much
Hypertention is a very bad ailment for me. it will strike whenever it finds its way to you.
This is one of the most discussed topic in our when we were still in college.
Pretty good post. I just came by your blog and wanted to say that I’ve really enjoyed reading your blog posts. In any case I’ll be subscribing to your feed and I hope you write again soon!
I also suffered from hyperthyroidism and yes symptoms are correct, you will lose weigh because it burns the fats before your body can process it, it can also cause your eyeball to pop out a little. There's nothing to worry because it's curable.
Thanks everyone for your comments.
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