General Medical Aspects of Endocrinology
The following brief review of a few of the interesting features of hyper and hypothyroidism, and hyper and hypoparathy-roidism is presented from a clinical standpoint.
Let us consider first some problems in the diagnosis of thyroid disorders.
Three conditions which commonly offer resistance to accurate diagnosis of thyroid disorders are (1) hyperthyroidism in remission, (2) neurocirculatory asthenia, and (3) hyperthyroidism masked as heart disease.
In recent years, the indiscriminate use of iodin has increased tremendously the difficulty of accurate diagnosis of thyroid disorders. Patients with hyperthyroidism are frequently seen who have been taking Lugol’s solution for several weeks, and at the time they present themselves for examination they may have very few symptoms or signs of hyperthyroidism remaining and the metabolism may be normal.
The essential factor in the diagnosis of hyperthyroidism in the case of such a remission is a painstaking history. Usually there is a characteristic onset of the condition with an increasing sense of stimulation warmth, hyperhidrosis, forceful tachycardia, tremor, loss of weight in spite of a good appetite, and distinct improvement after taking iodin. Histories of patients with diabetes or tuberculosis may bear a superficial resemblance to those of patients with hyper-thyroidism except for improvement on taking iodin in the case of the latter.
The most important finding from the physical examination is the general appearance of the patient. He is alert, he is apprehensive, the eyes have a brilliant stare, skin is flushed and perhaps a mild hostility may be noted. A similar appearance. . .