Killins,1 in a discussion of the diagnosis of exophthalmic goiter in elderly persons, points out the difficulty of recognizing the condition in patients over 55 years of age. He stresses the fact that there is "rarely a history of thyroid enlargement preceding the onset of the illness" and, furthermore, that even after the disease has been established for many months, swelling of the neck is unusual. That hyperthyroidism may exist without evidence of goiter is generally recognized by clinicians, though perhaps not thoroughly enough emphasized.
Tucker2 called attention to this fact when he reported three cases of hyperthyroidism in which there was no visible or palpable thyroid enlargement and in which the correct diagnosis was not suspected by three observers.
Mohler3 had previously reported a like number, of which one occurred in an elderly individual.
It is the latter type that concerns us particularly in this discussion,