Thyroid and other endocrine disorders

It would indeed be rash for a mere pathologist to venture forth on the uncharted sea of the endocrines, strewn as it is with the wrecks of shattered hypotheses, where even the most wary mariner may easily lose his way as he seeks to steer his bark amid the glandular temptations whose siren voices have proved the downfall of many who have gone before.

William Boyd (1885-1969)

Thyroid disorders can be a diagnostic trap in family practice and early diagnosis is a real challenge. A family practice of 2500 patients can expect one new case of thyroid disorder each year and ten 'cases' in the practice with a slight preponderance of hyperthyroid patients compared with hypothyroid patients. 1 The diagnosis of an overactive or underactive thyroid can be difficult as the early clinical deviations from normality can be subtle. The clinical diagnosis of classical Graves' disease is usually obvious with the features of exophthalmos, hyperkinesis and a large goitre but if the eye and neck signs are absent it can be misdiagnosed as an anxiety state. Elderly patients may present with only cardiovascular signs such as atrial fibrillation and tachycardia or with unexplained weight loss.

The hypothyroid patient can be very difficult to diagnose in the early stages, especially if the patient is being seen frequently. Hypothyroidism often has a gradual onset with general symptoms such as constipation and lethargy, and the diagnosis is usually made late by which time the disorder is quite florid in manifestation. If suspected, serum thyroid-stimulating hormone (TSH) should be requested.

Other endocrine disorders are relatively uncommon and therefore difficult to diagnose in the early stages of development. Certain symptoms (Table 20.1) alert one to the possibility of an endocrine disorder.

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