Goitrous Hypothyroidism Simulating Thyrotoxicosis

Summary A case of goitrous hypothyroidism in a boy of 13 is described which has been successfully treated with 260 mg of thyroid daily. The defect in this case may have been due to a failure in the coupling of iodotyrosines. For four years the patient was regarded as suffering from thyrotoxi‐cosis. This was largely due to the association of goitre with nervous manifestations, viz. excitability, tremor and moist palms. An incorrectly interpreted radio‐iodine uptake and an apparently raised B.M.R. were thought to support the diagnosis. Indications of the true diagnosis were the family history of goitre without iodine deficiency, the retarded physical development and bone age, the normal temperature of the palms, the failure to confirm the presence of the thyroid murmur, the absence of eye signs, the discrepancy between the sleeping and the waking pulse, the failure to respond antithyroid treatment and the good response to treatment with thyroid 30 mg three times daily before the diagnosis was established. The finding of a low P.B.I. clinched the diagnosis of hypothyroidism.