Hidden in plain sight: hyperthyroidism shrouded as gastrointestinal distress in a diabetic patient

Abstract

Thyroid hyperfunction usually manifests with typical symptoms such as palpitations, fatigue, heat intolerance, excessive sweating and polydipsia. Atypical presentation with gastrointestinal disorders in a known diabetic patient in a resource-poor environment could lead to misdiagnosis. Delay in diagnosis and treatment may occur due to a lack of classical symptoms of hyperthyroidism occurring on a background of immunosuppression due to diabetes mellitus (DM) in an environment where infectious causes of gastrointestinal symptoms abound. We report a case of a 53-year-old, known DM patient with no prior history of hyperthyroidism, who presented with spurious diarrhoea that eventually led to the diagnosis of hyperthyroidism. The report highlighted the importance of recognition of thyroid disorder in DM in the midst of confounding symptoms. It further emphasized that diarrhoea can present as a lone clinical feature of thyroid hyperfunction in some patients. Furthermore, it underscored the need for TSH levels monitoring after commencement of metformin therapy in diabetic patients.