DYSTHYROIDISM 115 
The immediate results afford some relief to the pa- 
tient, but it is difficult to say exactly how much it is 
necessary to remove in order to restore normal func- 
tion. When symptoms do not abate, a second operation 
with removal of more thyroid tissue is frequently re- 
sorted to. (Sloan,® Beebe*). The other extreme, oper- 
ative myxedema, is an infrequent subsequent develop- 
ment at the present time. 
Although improvement is the general rule following 
lobectomy, a complete and immediate cure is rarely the 
case. (Bram’). Surgery does not remove the cause, 
but rather the result of abnormal function. It is a dif- 
ference in degree only between this operation and that 
of removing the superior cervical sympathetic ganglion 
(Mayo*) for the cure of exophthalmos, an occasional 
symptom of dysthyroidism. 
Clinicians and surgeons both have come to recognize 
that dysthyroidism is a self-limited disease which runs 
its course and goes on to recovery (Stanton®). This 
being true, operative procedures merely modify the 
course and do not effect a cure. 
Thyroidectomy in this instance is comparable to 
splenectomy in pernicious anemia. In the latter case a 
remission is frequently produced, but the general course 
of the disease is but slightly altered and a fatal termi- 
nation is the inevitable outcome. 
This conception of thyroid conditions explains the 
lack of uniformly good results after sub-total thyroid- 
ectomy. The reduction of thyrotoxic symptoms will 
vary with the stage of the. disease present when oper- 
ation is performed. Those cases which continue to 
show signs of increased activity after operation are 
considered by surgeons as having had an insufficient 
amount of gland tissue removed. But more probably 
the disease had yet to run a portion of its course and 
lobectomy at that time had a less noticeable influence 
than the same operation done later. The following 
