DISGUISED THYROID DISORDERS.

In six cases of hyperthyroidism and two of chronic thyroiditis herein described, the initial features of the diseases were misinterpreted as attributable to other kinds of illness such as myocardial infarction, gastrointestinal malignant disease, malabsorption syndrome, psychosis, simple exophthalmos and endemic goiter. The characteristic signs and symptoms of hyperthyroidism (in six patients) and chronic thyroiditis (in two patients) were present at the outset but were not identified. Intensive questioning and alertness were required to elicit these characteristics. The symptoms improved or disappeared after the true disease was controlled. In the studies of these cases, the usefulness of a number of laboratory tests was illustrated-thyroid suppression studies, 4 to 6-hour and 24-hour radioactive iodine uptake, T(3) uptake by the red cells and determinations of 24-hour urine creatine, antithyroglobulin antibody titer and long-acting thyroid stimulating hormone.The manifestations of thyroid diseases are many and varied. The term "masked hyperthyroidism" may in part be a reflection of the "masked physician" unless he uses his clinical detective abilities.