100 INTERNAL SECRETION 



therefore, hyperthyroidism leads, as in Graves's disease, to 

 changes in the function of the ovaries; on the other, primary 

 changes in the activity of the sexual glands may exercise a 

 secondary influence upon the thyroid, and as a result, symptoms 

 resembling those of Graves's disease are produced. 



The brilliant results obtained by modern surgery in the 

 treatment of Graves's disease illustrate very clearly the etiological 

 connection between this condition and the thyroid gland. The 

 operative method is based upon the view that a reduction in the 

 volume of the gland, together with a decrease in, or prevention 

 of, its abnormal vascularization, must reduce its secretory activity 

 and so abolish the results of hypersecretion. The methods em- 

 ployed are : the ligature of one or more enlarged thyroid arteries ; 

 the extirpation of one-sided vascular goitres; and the resection 

 or excision of more than one half. Kocher found that these 

 measures were followed, in 76 per cent, of his cases, by complete 

 cure, and in another 14 per cent, by improvement. Similar 

 results are described by others. But there is a strong feeling 

 in many quarters that not all cases are suitable for operative 

 treatment, and that success largely depends upon the constitution 

 of the patient and, most important of all, upon conditions affecting 

 the thymus. Surgical treatment is accompanied by certain 

 dangers per se, and in a certain percentage of cases (3 to 4.7 per 

 cent.) operation has resulted in death. 



Another method of limiting the secretion of the goitrous 

 gland and perhaps, also of destroying the hypertrophic 

 parenchyma, is by means of the Rontgen rays (Gorl, 

 Stegmann, Holzknecht, &c.). Up to the present, however, no 

 very conclusive results as to the therapeutic value of this method 

 have been forthcoming. 



The results of organo-therapy in Graves's disease are 

 interesting only in so far as they furnish direct evidence against 

 the assumption of a hypothyrosis in this condition (v. Cyon, 

 Oswald). The effect produced by thyroid extract is, invariably, 

 the aggravation of the disease. 



Attempts to treat Graves's disease with extracts of the thymus, 

 ovary and suprarenal capsule, have a certain theoretic interest, but 

 are of no practical significance. 



The serum-therapy, first tried by Ballet and Enriquez, and 

 afterwards developed by Moebius, is founded upon the belief 

 that the surplus secretion formed by the hypertrophied thyroid 

 of Graves's disease can be employed to neutralize the toxins 

 contained in the serum of thyroidectomized animals. It is thought 

 that in this way the surplus is removed from the tissues which 

 have a specific affinity for the thyroid secretion, the reaction of 

 which would otherwise be manifested by pathological disturb- 

 ances. The serum of thyroidectomized animals, known as 

 Moebius's antithyroidin serum, and rhodagen, which, upon the 



