APATHETIC THYROIDISM: REVIEW OF THE LITERATURE AND REPORT OF FOUR CASES

Abstract

The clinical picture of Parry-Graves-Basedow disease has been well recognized for many years. However, recently has there been an increasing awareness of the atypical forms of this disease. The apathetic hyperthyroid patient, although not being masked by one disordered system, can be confusing and escape detection. This is due to his presenting little or no exophthalmos, goiter, tachycardia and other signs of activation. He is listless and insensitive and maintains dulled, expressionless eyes. These patients with apathetic thyroidism are usually older individuals who display cool, dry, wrinkled skin which is often pigmented. They exhibit greater weight loss than the typically agitated thyrotoxic, and they die in coma or stupor in contrast to storm.