32 



The Endocrine Organs 



siderably larger amount than usual (as much as 300 grammes) may be 

 taken without producing glycosuria. Nevertheless, glycosuria occurs 

 sometimes, but it is not excessive. 1 



Symptoms similar to those of myxoedema are produced as the result of 

 surgical removal of the thyroid in man (fig. 21). This was first apparent as 

 the result of the effects of operation for goitrous tumours (J. L. and A. 

 Reverdin, Th. Kocher). The Reverdins spoke of the condition as post- 

 operative myxoedema ; Kocher termed it cachexia strumipriva. It begins 

 to show itself at a variable period after operation — from a few days to 

 months or even years — and is more readily produced in young than in 



older subjects. It is sometimes 

 accompanied by symptoms of 

 tetany : when present, these 

 symptoms are presumably re- 

 ferable to involvement of 

 parathyroids. According to 

 Kocher, the patients rarely 

 survive the complete loss of 

 the thyroid for more than 

 seven years. To prevent ulti- 

 mate ill-effects at least one- 

 fourth of the organ must 

 be left. 



The above symptoms, 

 whether due to congenital 

 atrophy or to operative re- 

 moval, can be allayed or en- 

 tirely removed by successful 

 implantation of pieces of thy- 

 roid (Schiff) — an operation which has, however, rarely succeeded in man 

 — or by administration of thyroid substance or extract either hypoder- 

 mically (G. Murray) or by the mouth (Mackenzie and Fox). Patients 

 suffering from the effects of loss of thyroid secretion, whether this take the 

 form of cretinism, myxoedema, cachexia strumipriva, or endemic goitre, 

 can be completely restored to health and kept normal for apparently any 

 length of time by buccal administration of the gland or its extracts 

 (see figs. 18, 20, 22). If the treatment is intermitted the symptoms almost 

 at once begin to reappear. The effects are therefore obviously due to 

 the loss of an autacoid contained in the internal secretion. This autacoid 

 in some way affects the metabolic processes of the body, either directly or 

 indirectly promoting the nutrition of the connective tissues and influencing 

 the functions of the cells of the nervous system, particularly those of the 

 cerebral cortex. 



1 The alterations in metabolism in myxcedema and the effect of thyroid treatment upon 

 them have been studied in Tigerstedt's laboratory by J. A. Andersson (Hygeia, 1898). 



Fig. 21. — A case of post-operative myxoedema (cachexia 

 strumipriva) in a 26-year-old woman, (v. Brum) 



i/ 



