Abstract

Background: Elderly primary hypothyroidism is a common geriatric endocrine disease, with typical clinical manifestations including fatigue, lethargy, cold intolerance, and slow movement. Hypoglycemia is an atypical and rare initial symptom of hypothyroidism, which is extremely easy to be misdiagnosed as hypoglycemic encephalopathy, neurological diseases or diabetic abnormal glucose metabolism, leading to delayed diagnosis and missed standardized treatment. Case Presentation: We report a 72-year-old elderly female patient without a history of diabetes, hypoglycemia or endocrine diseases, who was admitted to the hospital with recurrent dizziness, fatigue and intermittent syncope for 1 month. Multiple random blood glucose tests during hospitalization showed persistent low glucose levels, with the lowest value of 2.1 mmol/L. After excluding common causes of hypoglycemia such as improper diet, insulin tumor, liver and renal dysfunction, and adrenal insufficiency, further thyroid function examination revealed significantly elevated thyroid-stimulating hormone and decreased free thyroid hormone levels, confirming the diagnosis of primary severe hypothyroidism. After standardized levothyroxine replacement therapy, the patient’s thyroid function returned to normal, and recurrent hypoglycemia symptoms were completely resolved without recurrence during 6 months of follow-up. Conclusion: Elderly hypothyroidism can be initiated by recurrent hypoglycemia without typical hypothyroid manifestations. For elderly patients with unexplained recurrent hypoglycemia, routine thyroid function screening should be performed to rule out atypical hypothyroidism, so as to avoid clinical misdiagnosis and delayed treatment.

Keywords: elderly patients; primary hypothyroidism; recurrent hypoglycemia; atypical manifestation; case report; misdiagnosis

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