Elderly Woman at 70 Diagnosed with Hypothyroidism After Presenting Abdominal Symptoms – Full Recovery Achieved Through Targeted Treatment
Disclaimer: This article is intended solely for educational and informational purposes. Patient privacy has been strictly protected, and all personal details have been anonymized or altered to maintain confidentiality.
Case Overview: From Misleading Symptoms to Accurate Diagnosis
A 70-year-old female patient was admitted to the hospital following persistent abdominal discomfort and reduced bowel movements. Initially suspected of suffering from incomplete intestinal obstruction, further diagnostic evaluation revealed a more complex underlying condition—severe hypothyroidism. With timely and targeted medical intervention, including hormone replacement therapy, her symptoms significantly improved. This case highlights the importance of comprehensive screening in elderly patients presenting with gastrointestinal issues, especially when symptoms appear atypical or unexplained.
Patient Profile & Clinical Background
Gender: FemaleAge: 70 years oldDiagnosis: Primary Hypothyroidism with Secondary Paralytic IleusHospital: Beijing Hospital (treated in February 2018)Treatment Plan: NPO (nothing by mouth), antispasmodic medication (Racemic Anisodamine), antibiotic therapy (Piperacillin Sodium and Tazobactam Sodium for injection), and Levothyroxine Sodium replacementTreatment Duration: 8-day inpatient care followed by a 3-month outpatient follow-up periodOutcome: Complete resolution of abdominal symptoms; thyroid function tests normalized during follow-up visits
Initial Assessment: A Puzzle of Gastrointestinal Symptoms
The patient presented with sudden-onset, continuous abdominal distension and pain one day prior to admission. She reported minimal flatulence and defecation, along with generalized fatigue—particularly noticeable in her lower limbs. Notably, she had no nausea, vomiting, chest tightness, or shortness of breath. Her medical history included chronic constipation, which had previously been managed without thorough investigation.
Physical examination revealed a conscious and stable individual. No jaundice or enlarged lymph nodes were observed. The abdomen was diffusely distended but soft, with mild tenderness across all quadrants and diminished bowel sounds. There was no rebound tenderness. Hepatosplenomegaly or palpable masses were absent. However, slight pitting edema was noted in both lower extremities—a subtle clue pointing toward possible systemic disease.
Diagnostic Workup Reveals Hidden Clues
Imaging studies played a crucial role in guiding diagnosis. A non-contrast CT scan of the abdomen and pelvis showed marked dilation of the ascending colon, wall thickening, and significant gas accumulation—findings consistent with partial bowel obstruction. Small amounts of free fluid were detected in the pelvic cavity, though no air-fluid levels suggestive of mechanical blockage were present.
Further investigations included vascular ultrasound of the abdominal aorta and major vessels, which ruled out ischemic causes. Blood work showed a white blood cell count of 8.2 × 10⁹/L—within normal limits—ruling out acute infection. However, cardiac enzyme testing raised concerns: AST was elevated at 81 U/L, CK reached 1297 U/L, and LDH measured 475 U/L. While troponin T remained low (<0.01 µg/L), indicating no active myocardial infarction, these elevations hinted at possible muscle involvement often seen in untreated hypothyroidism.
Uncovering the Root Cause: Hypothyroidism Identified
Given the unusual presentation and lack of clear obstructive pathology on imaging, clinicians ordered a full thyroid function panel. Results were striking: serum free T3 and free T4 levels were markedly decreased, while TSH, anti-thyroglobulin antibodies, and thyroid peroxidase antibodies were significantly elevated—confirming autoimmune hypothyroidism (Hashimoto's thyroiditis).
Upon detailed family interview, it emerged that the patient had experienced progressive changes over the past year following emotional stress due to a loved one's passing. These included cold intolerance, facial puffiness, slowed thinking, apathy, leg swelling, and unintentional weight gain of approximately 10 pounds (4.5 kg). Unfortunately, these signs had been dismissed as part of "normal aging."
An endocrinology consultation confirmed the diagnosis, leading to an immediate addition of oral Levothyroxine Sodium to her treatment regimen alongside continued supportive care.
Treatment Progress and Positive Outcome
Within three days of initiating thyroid hormone replacement, the patient's abdominal pain began to subside. Bowel function gradually returned, with restored flatus and defecation. Follow-up endoscopic evaluations—including gastroscopy, colonoscopy, and contrast-enhanced small bowel CT—revealed no structural abnormalities, supporting the diagnosis of hypothyroidism-induced paralytic ileus.
After eight days of in-hospital management, she was discharged in stable condition. Outpatient monitoring continued for three months, during which time she remained asymptomatic. Repeat thyroid function tests demonstrated normalization of TSH, free T4, and related markers, confirming effective treatment response.
Ongoing Care and Key Recommendations for Families
While the patient responded well to treatment, long-term management remains essential—especially given her advanced age and potential for symptom recurrence. Family caregivers play a vital role in ensuring ongoing health stability. Below are two critical recommendations:
1. Consistent Medication and Regular Monitoring
The patient must take Levothyroxine Sodium daily to maintain adequate thyroid hormone levels. Skipping doses or inconsistent timing can lead to fluctuating hormone levels, potentially triggering symptoms of either under- or over-replacement (such as hyperthyroidism).
During the initial phase post-discharge, thyroid function should be checked every two weeks. Once stabilized, testing can be spaced to every 1–3 months. Dosage adjustments should always be based on lab results and clinical assessment—not self-modified by the patient or caregiver.
2. Vigilant Observation of Physical and Cognitive Changes
Families should monitor for early warning signs such as:
- New or worsening fatigue
- Swelling in the face, hands, or legs
- Changes in mood, memory, or alertness
- Constipation returning or worsening
- Unexplained weight fluctuations
If any of these occur, prompt medical evaluation is necessary to prevent complications like myxedema coma—an extremely rare but life-threatening consequence of untreated severe hypothyroidism.
Clinical Insights: Why Hypothyroidism Should Never Be Overlooked in Older Adults
Hypothyroidism is a systemic disorder caused by insufficient production or action of thyroid hormones. It disproportionately affects women and increases in prevalence with age. However, its symptoms are often nonspecific—fatigue, weight gain, cold sensitivity, dry skin, depression—and easily attributed to aging or other comorbid conditions.
This case underscores how hypothyroidism can manifest in unexpected ways, such as gastrointestinal dysmotility. Reduced sympathetic nervous system activity slows gut motility, promotes mucopolysaccharide deposition in intestinal walls, and leads to myxedematous changes that impair nerve conduction within the enteric nervous system. The result? Functional bowel obstruction without physical blockage—commonly known as paralytic ileus.
In older adults, where chronic constipation is common, this root cause may go undiagnosed for years. Treating only the symptom—with laxatives or enemas—offers temporary relief but fails to address the real issue. Without proper diagnosis, patients remain at risk for recurrent episodes or even thyroid crisis.
Best Practice Takeaway for Clinicians
When evaluating elderly patients with unexplained gastrointestinal disturbances—especially those involving slowed motility, bloating, or pseudo-obstruction—routinely screen for thyroid dysfunction. Including a simple TSH and free T4 test in the initial workup can uncover hidden endocrine disorders and dramatically alter treatment outcomes.
Early detection not only improves quality of life but can also prevent hospitalization, reduce polypharmacy, and avoid invasive procedures that might otherwise be pursued due to misdiagnosis.