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Graves' Disease: Influence of Age on Clinical Findings

Graves' Disease: Influence of Age on Clinical Findings Abstract • To determine the influence of age on the signs and symptoms of hyperthyroidism we prospectively examined 880 patients and matched them by age, sex, race, and visit date with similarly examined euthyroid control subjects. Many signs and symptoms showed little change with age until after the fifth decade of life when they began to decrease gradually. Findings that increased with age were weight loss and atrial fibrillation, while those that decreased most markedly with age were increased appetite and weight gain. The diagnosis is more difficult as age progresses because there are fewer findings and because the significance of those present may not be appreciated. Identification of the most sensitive and specific signs and symptoms in each age decade should improve the early detection of hyperthyroidism. (Arch Intern Med 1988;148:626-631) References 1. Williams RH: Thiouracil treatment of thyrotoxicosis: I. The results of prolonged treatment. J Clin Endocrinol Metab 1946;6:1-22.Crossref 2. Wayne EJ: The diagnosis of thyrotoxicosis. Br Med J 1954;1:411-419.Crossref 3. Overall JE, Williams CM: Conditional probability program for diagnosis of thyroid function. JAMA 1963;183:307-313.Crossref 4. Lamberg BA, Heinonen OP, Aro A, et al: Statistical evaluation of symptoms and clinical signs in the diagnosis of hyperthyroidism. Acta Endocrinol 1970;146( (suppl) ):37-42. 5. Oddie TH, Boyd CM, Fisher DA, et al: Incidence of signs and symptoms of thyroid disease. Med J Aust 1972;2:981-986. 6. Mornex R, Orgiazzi JJ: Hyperthyroidism , in DeVisscher M (ed): The Thyroid Gland . New York, Raven Press, 1980, pp 279-362. 7. Saxena KM, Crawford JD, Talbot NB: Childhood thyrotoxicosis: A long-term perspective. Br Med J 1964;2:1153-1158.Crossref 8. Gupta SP, Ahuja MMS: Hyperthyroidism in children and young adolescents: A clinical profile—problems in diagnosis and management. J Assoc Physicians India 1972;20:737-743. 9. Davis PJ, Davis FB: Hyperthyroidism in patients over the age of 60 years: Clinical features in 85 patients. Medicine 1974;53:161-181.Crossref 10. Seed L, Lindsay AM: Hyperthyroidism in the aged: A review of 100 cases over 60 years of age. Geriatrics 1949;4:136-145. 11. Stiel JN, Hales IB, Reeve TS: Thyrotoxicosis in an elderly population. Med J Aust 1972;2:986-988. 12. Ronnov-Jessen V, Kirkgaard C: Hyperthyroidism—a disease of old age? Br Med J 1973;1:41-43.Crossref 13. Kawabe T, Komiya I, Endo T, et al: Hyperthyroidism in the elderly. J Am Geriatr Soc 1979;27:152-155. 14. DeGroot LJ, Larsen PR, Refetoff S, et al: The Thyroid and Its Diseases , ed 5. New York, John Wiley & Sons Inc, 1984, pp 732-752. 15. Nordyke RA, Kulikowski CA, Kulikowski CW: A comparison of methods for the automated diagnosis of thyroid dysfunction. Comput Biomed Res 1971;4:374-389.Crossref 16. Werner SC, Spooner M: A new and simple test for hyperthyroidism employing L-triiodothyronine and the 24-hour I-131 uptake method. Bull NY Acad Med 1955;31:137-145. 17. Shenkman L, Suphavai A, Mitsuma T, et al: Triiodothyronine and thyroid-stimulating hormone response to thyrotropin-releasing hormone: A new test of thyroidal and pituitary reserve. Lancet 1972;1:111-113.Crossref 18. Feinstein AR: An additional basic science for clinical medicine: IV. The development of clinimetrics. Ann Intern Med 1983;99:843-848.Crossref 19. Nordyke RA, Gilbert FI Jr: Achilles reflex thyroid function test: Evaluation of a new instrument. Am J Med Sci 1970;259:419-423.Crossref 20. Fleiss JL: Statistical Methods for Rates and Proportions . New York, John Wiley & Sons Inc, 1973, pp 96-99. 21. Armitage P: Statistical Methods in Medical Research . Boston, Blackwell Scientific Publications Inc, 1971, p 311. 22. Dixon WJ, Massey FJ: Introduction to Statistical Analysis . New York, McGraw-Hill International Book Co, 1983, pp 121-122. 23. Ratio of Males to Females, by Age Group, 1910 to 1981, and by Race, 1981: Statistical Abstract of the United States: 1982-83 , ed 103. Washington, DC, US Bureau of the Census, 1982. 24. Oddie TH, Fisher A, McConahey WM, et al: Iodine intake in the United States: A reassessment. J Clin Endocrinol Metab 1970;30:659-665.Crossref 25. Benker G, Reinwein D, Schleusener H, et al: A prospective survey of hyperthyroidism in different regions of Europe. Endocrinology 1986;119 ( (suppl) ):T-67. 26. Greenwood RM, Daly JG, Himsworth RL: Hyperthyroidism and the impalpable thyroid gland. Clin Endocrinol 1985;22:583-587.Crossref 27. Tibaldi JM, Barzel US, Albin J, et al: Thyrotoxicosis in the very old. Am J Med 1986;81:620-622.Crossref 28. MacLennan R, Gaitan E, Miller MC: Observer variation in grading and measuring the thyroid in epidemiological surveys , in Stanbury JB (ed): Endemic Goitre . Geneva, World Health Organization, 1969, pp 66-77. 29. Hoffman L, Lowrey RD: The electrocardiogram in thyrotoxicosis. Am J Cardiol 1960;6:893-904.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Graves' Disease: Influence of Age on Clinical Findings

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References (30)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1988.00380030132023
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Abstract

Abstract • To determine the influence of age on the signs and symptoms of hyperthyroidism we prospectively examined 880 patients and matched them by age, sex, race, and visit date with similarly examined euthyroid control subjects. Many signs and symptoms showed little change with age until after the fifth decade of life when they began to decrease gradually. Findings that increased with age were weight loss and atrial fibrillation, while those that decreased most markedly with age were increased appetite and weight gain. The diagnosis is more difficult as age progresses because there are fewer findings and because the significance of those present may not be appreciated. Identification of the most sensitive and specific signs and symptoms in each age decade should improve the early detection of hyperthyroidism. (Arch Intern Med 1988;148:626-631) References 1. Williams RH: Thiouracil treatment of thyrotoxicosis: I. The results of prolonged treatment. J Clin Endocrinol Metab 1946;6:1-22.Crossref 2. Wayne EJ: The diagnosis of thyrotoxicosis. Br Med J 1954;1:411-419.Crossref 3. Overall JE, Williams CM: Conditional probability program for diagnosis of thyroid function. JAMA 1963;183:307-313.Crossref 4. Lamberg BA, Heinonen OP, Aro A, et al: Statistical evaluation of symptoms and clinical signs in the diagnosis of hyperthyroidism. Acta Endocrinol 1970;146( (suppl) ):37-42. 5. Oddie TH, Boyd CM, Fisher DA, et al: Incidence of signs and symptoms of thyroid disease. Med J Aust 1972;2:981-986. 6. Mornex R, Orgiazzi JJ: Hyperthyroidism , in DeVisscher M (ed): The Thyroid Gland . New York, Raven Press, 1980, pp 279-362. 7. Saxena KM, Crawford JD, Talbot NB: Childhood thyrotoxicosis: A long-term perspective. Br Med J 1964;2:1153-1158.Crossref 8. Gupta SP, Ahuja MMS: Hyperthyroidism in children and young adolescents: A clinical profile—problems in diagnosis and management. J Assoc Physicians India 1972;20:737-743. 9. Davis PJ, Davis FB: Hyperthyroidism in patients over the age of 60 years: Clinical features in 85 patients. Medicine 1974;53:161-181.Crossref 10. Seed L, Lindsay AM: Hyperthyroidism in the aged: A review of 100 cases over 60 years of age. Geriatrics 1949;4:136-145. 11. Stiel JN, Hales IB, Reeve TS: Thyrotoxicosis in an elderly population. Med J Aust 1972;2:986-988. 12. Ronnov-Jessen V, Kirkgaard C: Hyperthyroidism—a disease of old age? Br Med J 1973;1:41-43.Crossref 13. Kawabe T, Komiya I, Endo T, et al: Hyperthyroidism in the elderly. J Am Geriatr Soc 1979;27:152-155. 14. DeGroot LJ, Larsen PR, Refetoff S, et al: The Thyroid and Its Diseases , ed 5. New York, John Wiley & Sons Inc, 1984, pp 732-752. 15. Nordyke RA, Kulikowski CA, Kulikowski CW: A comparison of methods for the automated diagnosis of thyroid dysfunction. Comput Biomed Res 1971;4:374-389.Crossref 16. Werner SC, Spooner M: A new and simple test for hyperthyroidism employing L-triiodothyronine and the 24-hour I-131 uptake method. Bull NY Acad Med 1955;31:137-145. 17. Shenkman L, Suphavai A, Mitsuma T, et al: Triiodothyronine and thyroid-stimulating hormone response to thyrotropin-releasing hormone: A new test of thyroidal and pituitary reserve. Lancet 1972;1:111-113.Crossref 18. Feinstein AR: An additional basic science for clinical medicine: IV. The development of clinimetrics. Ann Intern Med 1983;99:843-848.Crossref 19. Nordyke RA, Gilbert FI Jr: Achilles reflex thyroid function test: Evaluation of a new instrument. Am J Med Sci 1970;259:419-423.Crossref 20. Fleiss JL: Statistical Methods for Rates and Proportions . New York, John Wiley & Sons Inc, 1973, pp 96-99. 21. Armitage P: Statistical Methods in Medical Research . Boston, Blackwell Scientific Publications Inc, 1971, p 311. 22. Dixon WJ, Massey FJ: Introduction to Statistical Analysis . New York, McGraw-Hill International Book Co, 1983, pp 121-122. 23. Ratio of Males to Females, by Age Group, 1910 to 1981, and by Race, 1981: Statistical Abstract of the United States: 1982-83 , ed 103. Washington, DC, US Bureau of the Census, 1982. 24. Oddie TH, Fisher A, McConahey WM, et al: Iodine intake in the United States: A reassessment. J Clin Endocrinol Metab 1970;30:659-665.Crossref 25. Benker G, Reinwein D, Schleusener H, et al: A prospective survey of hyperthyroidism in different regions of Europe. Endocrinology 1986;119 ( (suppl) ):T-67. 26. Greenwood RM, Daly JG, Himsworth RL: Hyperthyroidism and the impalpable thyroid gland. Clin Endocrinol 1985;22:583-587.Crossref 27. Tibaldi JM, Barzel US, Albin J, et al: Thyrotoxicosis in the very old. Am J Med 1986;81:620-622.Crossref 28. MacLennan R, Gaitan E, Miller MC: Observer variation in grading and measuring the thyroid in epidemiological surveys , in Stanbury JB (ed): Endemic Goitre . Geneva, World Health Organization, 1969, pp 66-77. 29. Hoffman L, Lowrey RD: The electrocardiogram in thyrotoxicosis. Am J Cardiol 1960;6:893-904.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Mar 1, 1988

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