An unexpected diagnosis of Graves’ disease in an 81-year-old female with altered mental status

Abstract

Graves’ disease accounts for most cases of hyperthyroidism across all age groups, however, incident cases become increasingly uncommon with advanced age. In addition, geriatric patients often present without classic features of hyperthyroidism, further increasing the difficulty in making this diagnosis. We report a case of an 81-year-old female presenting with altered mental status on a background of dementia and apathy who ultimately was found to have new onset Graves’ disease. She responded to low dose methimazole therapy without any adverse events. This case emphasizes the importance of maintaining thyroid disorders on the differential diagnosis for elderly patients presenting to hospital with altered mental status, as this condition is highly treatable and can prevent significant morbidity.

Keywords

• Graves disease
• Elderly
• Thyroid uptake scan
• Methimazole