THE THYROID-OVARIAN SYNDROME 99 
anemia. Laboratory examinations: Urine faint trace 
of albumen. Sp.gr. 1010 to 1014, few hyaline casts. 
CASES WITH INITIAL DYSTHYROIDISM 
The cases which commence with thyroid disturbances 
first complain of a series of symptoms similar to those 
usually associated with chronic nephritis. Frequently 
the first symptom is a headache, which comes on early 
in the morning, often awakening the patient from sleep 
and lasting until midday. Dizziness and double vision 
are also frequent occurrences. If the blood pressure be 
taken at this period it will be found to be increased, in 
some cases alarmingly so, 200 mm. of mercury being 
not infrequent. This increase in blood pressure in 
women at the menopause has been commented upon by 
others. A gradual development of trophic or metabolic 
disturbances follows. There is frequent complaint of 
itching. The hands are described as feeling boggy and 
stiff in the morning, finger rings being turned around 
with difficulty then, and without difficulty later in the 
day. There is a slight edema of the legs and the skin 
feels puffy. 
Physical examination shows little or no change from 
the normal. Occasionally the second aortic heart sound 
is accentuated. Laboratory examinations for kidney 
involvement are negative. Occasionally there are mild 
or severe evidences of hyperfunction (4 of 16 cases) 
with nervous irritability, and in one case glycosuria. 
In two cases a temperature varying from 99.4° to 
100.8° F. (per os) persisted for eighteen months to two 
years without demonstrable cause. 
The onset of these symptoms is rather acute and they 
last with varying severity from two to seven or eight 
years. The skin during this period gradually becomes 
drier; there is a marked gain in weight, averaging in 
twenty-seven cases, 35 lbs.; the hair becomes brittle. 
The types commencing as thyroid dysfunction usually 
