THE THYROID-OVARIAN SYNDROME 107 
As has been stated before, the key to successful or- 
ganotherapy is a consideration and understanding of 
physiology. The initial symptom of the ovarian type, 
namely, backache, is possibly of purely mechanical 
origin. The relief at the menstrual epoch makes it 
seem probable that the pain is brought about by pres- 
sure from within the organ which stretches the cap- 
sule. The radiation of the pain is explainable by the 
innervation, nevertheless, the persistence of pain after 
odphorectomy is against such an explanation. 
The first symptom referable to dysfunction is a par- 
tial loss of secondary sexual characteristics. The loss 
of function as applied to the menstrual cycle is the last 
to appear. Occasionally the organism makes a violent 
attempt to keep up its function and this is clinically 
manifested by a profuse menstruation. Finally the 
menstrual stimulation becomes less and less and ame- 
norrhea is the clinical manifestation. The ovary is in 
intimate connection with the thyroid, a fact well known 
to all. The pituitary relationship is just as evident, for 
activity of the ovary (pregnancy) frequently is accom- 
panied by an almost adenomatous proliferation of the 
pituitary. 
The thyroid behaves in a manner somewhat analo- 
gous to the ovary. The first insufficiency is one of de- 
creased catabolic metabolism indicated by increase in 
weight. As with the ovary, occasionally the gland, in 
a final effort at compenstaion, works overtime and 
nervous irritability, glycosuria, or temperature changes 
may be the clinical result, just as these symptoms so 
often are seen in atypical cases of Graves’ disease. It 
is probable, but not proved, that the normal thyroid to 
some degree inhibits pituitary activity. When this 
inhibition is removed, i. e., when there is thyroid dys- 
function, there is hyperpituitarism indicated by high 
blood pressure and headache. This is the reverse of 
the ovarian type where hypopituitarism occurs as is 
