Hyperthyroidism in the Extremes of Life
Hyperthyroidism is rarely encountered in patients in the extremes of life. In a series of 13,200 consecutive cases of hyperthyroidism seen at the Cleveland Clinic since 1925, there have been only 42 cases in children under 14 years of age and only 45 cases in patients beyond the age of 70. The youngest child undergoing thyroidectomy for hyperthyroidism was a boy of 2½ years and the oldest patient was a man 81 years of age. (Figs. 1 and 2.)
The reaction of the feeble and elderly patient to hyperthyroidism and to thyroidectomy is quite different from that of the child or the young adult. A comprehension of these differences is of value not only in the treatment of the rare cases of hyperthyroidism occurring in children and in old age, but also in the management of the numerous cases of hyperthyroidism in patients in the fifth and sixth decades of life.
In this series, hyperthyroidism in children was always associated with a diffuse enlargement of the thyroid whereas adenomatous glands were present in 96 per cent of the patients over 70 years of age. In the aged, the clinical picture of hyperthyroidism is distorted by the myocardial, vascular, and cerebral changes of senility. Striking differences in the clinical expression of hyperthyroidism in children and in the aged are therefore found.
Exophthalmos occurred in 76 per cent of the children in this series, and in 14 per cent of the cases it appeared so early and was so marked that it. . .