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Catherine Alguire, Jessica Chbat, Isabelle Forest, Ariane Godbout, and Isabelle Bourdeau

report the case of a patient who had severe refractory anxiety as a presenting symptom of pheochromocytoma. After 13 years of psychiatric follow-up, the patient was finally diagnosed with malignant pheochromocytoma. Atypical and refractory cases of severe

Open access

Marcela Rodríguez Flores, Ruth Carmina Cruz Soto, Verónica Vázquez Velázquez, Reina Ruth Soriano Cortés, Carlos Aguilar Salinas, and Eduardo García García

anxiety and binge of carbohydrate-rich beverages. Accordingly, management was directed toward more intensive psychological counseling to increase stress-reducing activities, and identification/modification of dysfunctional responses, including substitution

Open access

Elizabeth M Madill, Shamil D Cooray, and Leon A Bach


Thyrotoxicosis is an under-recognised but clinically important complication of parathyroidectomy. We report a case of a 37-year-old man with tertiary hyperparathyroidism who initially developed unexplained anxiety, diaphoresis, tachycardia, tremor and hyperreflexia one day after subtotal parathyroidectomy. Thyroid biochemistry revealed suppressed thyroid stimulating hormone and elevated serum free T4 and free T3 levels. Technetium-99m scintigraphy scan confirmed diffusely decreased radiotracer uptake consistent with thyroiditis. The patient was diagnosed with thyrotoxicosis resulting from palpation thyroiditis. Administration of oral beta-adrenergic antagonists alleviated his symptoms and there was biochemical evidence of resolution fourteen days later. This case illustrates the need to counsel patients about thyroiditis as one of the potential risks of parathyroid surgery. It also emphasises the need for biochemical surveillance in patients with unexplained symptoms in the post-operative period and may help to minimise further invasive investigations for diagnostic clarification.

Learning points

  • Thyroiditis as a complication of parathyroidectomy surgery is uncommon but represents an under-recognised phenomenon.
  • It is thought to occur due to mechanical damage of thyroid follicles by vigorous palpation.
  • Palpation of the thyroid gland may impair the physical integrity of the follicular basement membrane, with consequent development of an inflammatory response.
  • The majority of patients are asymptomatic, however clinically significant thyrotoxicosis occurs in a minority.
  • Patients should be advised of thyroiditis/thyrotoxicosis as a potential complication of the procedure.
  • Testing of thyroid function should be performed if clinically indicated, particularly if adrenergic symptoms occur post-operatively with no other cause identified.

Open access

E S Scott, G R Fulcher, and R J Clifton-Bligh

18 mmol/L, with daily hypoglycaemia (particularly nocturnal) and an HbA1c of 8.1% (65 mmol/mol). She reported severe anxiety that impacted her daily life. 18 months post her completion of pancreatectomy, she was commenced on CSII and CGM via the

Open access

I R Wallace, E Healy, R S Cooke, P K Ellis, R Harper, and S J Hunter

. Case presentation A 43 year-old woman presented with a 3 month history of three stone weight loss, palpitations, anxiety, heat intolerance, sleep disturbance, tremor and increased energy. She had initially attributed her symptoms to stress, working in

Open access

Arshiya Tabasum, Ishrat Khan, Peter Taylor, Gautam Das, and Onyebuchi E Okosieme

be followed up with annual thyroid function tests. Outcome and follow-up Twenty-four months after initial presentation, she developed symptoms of anxiety, sweating, tremor, and palpitations. She had no goiter or eye signs. Her thyroid hormone

Open access

V Larouche, L Snell, and D V Morris

blood pressure of 167/109, a heart rate of 157 and a 1-week history of anxiety and paranoid ideations. She was newly distrustful of everyone around her and extremely jealous. Psychotic behaviours were witnessed in the emergency room. For example, she was

Open access

Guadalupe Vargas, Lourdes-Josefina Balcazar-Hernandez, Virgilio Melgar, Roser-Montserrat Magriña-Mercado, Baldomero Gonzalez, Javier Baquera, and Moisés Mercado

associated with nausea, vomiting or visual abnormalities. She also complained of anxiety, insomnia and occasional palpitations for about 6 months, but specifically denied acral changes and galactorrhea. She did not smoke or abuse alcohol or recreational drugs

Open access

Catherine D Zhang, Pavel N Pichurin, Aleh Bobr, Melanie L Lyden, William F Young Jr, and Irina Bancos

surgeon for suspected Cushing syndrome. She reported a 34 kg weight gain over 1 year, red abdominal striae, rounding of the face and worsening anxiety. She denied exogenous corticosteroid use, with the exception of intra-articular hip injections. She was

Open access

Annika Sjoeholm, Cassandra Li, Chaey Leem, Aiden Lee, Maria P Stack, Paul L Hofman, and Benjamin J Wheeler

had experienced photophobia, neck stiffness, headaches, and lethargy. Further history unmasked an insidious 8-week period of worsening frontal and occipital headaches, associated with anxiety, diaphoresis, palpitations and intermittent vomiting