Severe HypoproteinemiaAn Unusual Manifestation of Thyrotoxicosis

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Abstract
That the manifestations of thyrotoxicosis are protean is attested to by the abundance of literature on this subject. The typical syndrome of physical stimulation, tremor, tachycardia, loss of weight, polyphagia, and intolerance to heat associated with thyroidal enlargement and ocular signs is not difficult to recognize. Other patients, however, may appear to have refractory congestive heart failure or chronic cardiac arrythmia. Severe anxiety, psychosis, or encephalopathic manifestations may obscure the basic disease. Innumerable other variations have been observed mimicking osteoporosis, gastrointestinal disease, rheumatic states, and myasthenia gravis. Two recent reports5,19 dealing with bizarre manifestations of hyperthyroidism mentioned edema as an occasional presenting complaint. In such cases, the mechanism of the edema is unknown, for it is said that cardiac, renal, hepatic, nutritional, obstructive, and protein abnormalities can be excluded. Plasma protein abnormalities, when sought, are commonly observed with thyrotoxicosis.1,10,12 However, the changes seen are not of the magnitude