Beriberi (Thiamine Deficiency) Differential Diagnoses

Updated: Mar 02, 2017
  • Author: Dieu-Thu Nguyen-Khoa, MD, FACP; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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DDx

Diagnostic ConsiderationsHyperthyroidism and/or thyrotoxicosis

Conditions to consider in the differential diagnosis of thiamine deficiency include the following:

  • Hepatic failure
  • Alcoholic cardiomyopathy
  • Cardiomyopathy in diabetic heart disease
  • Cardiomyopathy secondary to other etiologies
  • Delirium
  • Delirium tremens
  • Delusional disorder
  • Dementia due to human immunodeficiency virus (HIV) disease
  • Depression
  • Dermatomyositis
  • Diabetic ketoacidosis
  • Hepatic encephalopathy
  • Hypertensive encephalopathy
  • Uremic encephalopathy
  • Enterobacter infections
  • Enteroviruses
  • Folic acid deficiency
  • Hyperthyroidism
  • Ileus
  • Irritable bowel syndrome
  • Metabolic acidosis
  • Myocarditis
  • Nerve entrapment syndromes
  • Polymyositis
  • Schizophreniform disorder
  • Scurvy
  • Wernicke-Korsakoff syndrome

When examining a patient with high-output cardiac failure, thyrotoxicosis is an important differential diagnosis to consider and treat, although no definite clinical correlation has been found between thiamine and thyroid disease. Only animal studies suggest any benefit in administering thiamine to treat patients with thyrotoxicosis.

If thyrotoxicosis is suspected, the treatment must be directed at protecting the heart from the thyroid storm, as opposed to supporting the cardiac output while increasing the thiamine level. However, because no damage is expected from administering supplemental thiamine to patients with thyrotoxicosis, the use of thiamine in the treatment of these patients is innocuous and may be helpful.

Differential Diagnoses