Non-Activated (Apathetic) Type of Hyperthyroidism

Abstract

AT various times during the past few years, we have discussed in other parts of the country a type of thyroidism which we have termed "apathetic thyroidism," but have said and written little about it in New England.Since this condition is one about which textbooks make little or no mention, one that is little appreciated and often unrecognized, and since it is one with very serious potential possibilities, it seems worth while to describe the condition in a journal read throughout New England.We have for several years now, particularly in recent years, stated that there are very distinctly two types of thyroidism, the so-called activated type and the so-called non-activated or what we have termed the apathetic type of thyroidism. Activated thyroidism is usually not difficult to recognize characterized as it is by its striking eye signs of stare or exophthalmos, its usually enlarged and firm thyroid, its striking pulse rate, its obvious tremor and its typical activation. Hyperthyroidism of the activated type when at all intense is not only very obvious from a diagnostic point of view, but it is capable of demonstrating itself by these same obviously diagnostic features as a state of the disease possessing very serious possibility of a fatality.There exists, however, a different type of hyperthyroidism not characterized by these striking features, not possessing the obvious evidences of possible fatality and definitely possessing unsuspected ability to result fatally upon the addition of any extra burden in the way of an operative procedure. A comparison of some of the clinical features of the two conditions will be of value in our endeavor to describe this condition.Typical hyperthyroidism of the activated type is most characteristically seen in young girls with their unimpaired bodies capable of the greatest degree of reactive ability. Apathetic hyperthyroidism is typically seen in the more senile individuals from middle age on with their lessened capacity for reaction to such a toxicity as occurs with hyperthyroidism. Activated hyperthyroidism is characterized either by stare or by exophthalmos, while patients with apathetic hyperthyroidism, as a rule, *Lahey\p=m-\Director, Lahey Clinic. For record and address of author see "This Week's Issue", page 783. do not show eye signs. Their eyes as a rule are in repose.The thyroid itself in typical activated hyperthyroidism is usually definitely enlarged often two or three times beyond the normal size ; while the thyroid in apathetic hyperthyroidism is frequently small, even smaller than normal, but usually of a firm, pebbly character due to the fact that the hyperthyroidism has existed over a long period of time.The apex beat in activated hyperthyroidism is quite typically forceful, usually being diffused forcefully over the entire precordium, while the apex beat in apathetic hyperthyroidism is not forceful, it is not thrusting in character and is distinctly not diffused over the precordium and not impressive in character.The character of the pulse in activated hyperth...

Thyroid Storm Associated with Probable Subclinical Hypoadrenocorticism in an Elderly Woman.

“…The relatively higher level of free T4 as compared with the level of total T4, and the presence of moderate leukocytosis in the absence of infection were highly suggestive of thyroid storm in this case (1,6). A depressed or apathetic state can be a prominent finding in elderly hyperthyroid patients, a condition termed apathetic hyperthyroidism (7). It becomes difficult to differentiate this condition from the altered mental state due to thyroid storm.…”

Psychosomatic View of Endocrine Disorders

“…Whybrow et al [68] observed depression in 2 of 10 patients, and provided evidence for an impairment of cog nitive function, although not as severe as with hypothyroidism. Apathetic hyperthyroidism, first described by Lahey [69], is a condition where the typical manifestations of thyroid hyperactivity are absent, while apathy, car diovascular symptoms, and depression pre vail [70]. Such depression may improve dra matically with the correction of thyrotoxico sis [69][70][71][72] while it appears not to respond to antidepressants [71][72][73].…”

“…Apathetic hyperthyroidism, first described by Lahey [69], is a condition where the typical manifestations of thyroid hyperactivity are absent, while apathy, car diovascular symptoms, and depression pre vail [70]. Such depression may improve dra matically with the correction of thyrotoxico sis [69][70][71][72] while it appears not to respond to antidepressants [71][72][73]. Kathol and Dclahunt [74] applied DSM-III criteria to a sam ple of 32 newly diagnosed patients suffering from hyperthyroidism and found that 10 of them presented with a major depressive epi sode.…”

Surgical Management of Hyperthyroidism

“…It is important for clinicians to remember that these may be more subtle in the elderly population who may present with fatigue or weakness, a condition known as apathetic hyperthyroidism, or with predominantly cardiovascular signs such as atrial fibrillation, ischaemic heart disease and congestive cardiac failure [4,5]. The routine use of serum thyrotropin (TSH) as a screening investigation may allow earlier identification and treatment of the disease [6,7].…”