From a surgical perspective, i note that you have not mentioned the cause of hyperthyroidism in your case. Was it Graves' disease or a toxic adenoma or something else.The reason why it is important is that Graves' diseae, is usually associated with anemia, rather than erythrocytosis or polycythemia. Erythroid bone marrow hyperplasia is commonly seen and usually they develop features of an iron deficiency anemia as this condition often affects menstuating women.
One condition that can cause nocturnal sweating is hypoglycemia. This may be,
- chronic idiopathic hypoglycemia,
- hypoglycemia associated with insulin therapy in diabetics, or
- caused by insulinomas.
Insulinomas may be
- sporadic or
- occur in association with multiple endocrine neoplasia (MEN 1).
Insulinomas generally need the presence of the 'Whipple triad' and laboratory evidence of hyperinsulinemic hypoglycemia for the diagnosis. But atypical cases do occur, and can be very difficult to diagnose.Sometimes, the hypoglycemia can be purely nocturnal and in such cases, the affected individuals may only recall sweating among the neuroglycopenic symptoms.
The components of MEN 1 syndrome are as follows,
- pitutary tumors,
- Hyperparathyroidism (the most common),
- Pancreatic islet cell tumors(the second most common),
- insulinomas (20-35% of functional pancreatic islet cell tumors),
- carcinoid tumors,and
- Thyroid adenomas (5-30% of patients).
As Dr.Jagesh has suggested, your thyroid function needs to be re-assessed first. If you are euthyroid, then other causes need to be excluded.
MB BS, MS, FRCS(Edinburgh)