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November 23, 1957


JAMA. 1957;165(12):1533-1536. doi:10.1001/jama.1957.02980300013004

An analysis is made of 228 cases in which surgery had been advised elsewhere on the basis of a misdiagnosis of hyperthyroidism. The corrected diagnosis was nervous tension and exhaustion in 112 cases; menopause, 30; physical exhaustion, 27; normal, 11; colloid goiter, 11; rheumatic endocarditis, 3; psychoneurosis, 8; hypothyroidism, 6; and miscellaneous, 20. It is believed that in the first (largest) group the most important single factor was the excessive use of coffee, tea, and tobacco; these were sometimes used in surprising amounts, sufficient to explain the nervous tension, tremor, insomnia, cardiovascular disorders, and weight loss. Determinations of basal metabolic rate gave useful information when repeated on different days with due care by experienced technicains; single determinations prove misleading. For a diagnosis of hyperthyroidism the basal metabolic rate, the proteinbound iodine test, and the radioatcive iodine test should all be significant. If the two lastnamed are not available, the iodine test should be done, consisting of the administration of 10 drops of strong iodine solution (Lugol's solution) three times a day for 10 days. Cautions in performing and interpreting this test are noted. Thyroidectomy is not an emergency operation, and needs to be justified by complete diagnostic information.