DYSTHYROIDISM i Pal 
roidism suggests that it probably plays some rdle in 
this disease. The power of the Roentgen rays to affect 
thymus as well as thyroid hypertrophy, is a strong 
point in favor of their use. (Holmes & Merrill *’.) 
In addition to the probable involvement of chromaffin 
and thymus tissue in dysthyroidism, as already men- 
tioned, there is the well-known fact of anterior pitui- 
tary hypertrophy following thyroidectomy, all of which 
add support to the contention that it is not a disease 
of the thyroid alone. Bertine** found that out of 134 
cases of the thyroid disease at least 60, almost half, 
presented features indicating disturbance in other en- 
docrine glands. It becomes apparent that no endocrine 
gland “exists unto itself alone.”” Nowhere in the realm 
of medicine is there a better illustration of the dic- 
tum, “There are no pigeonholes in nature,” than in 
diseases of the ductless glands. This complexity makes 
their study and treatment a difficult problem, one which 
internal medicine alone may solve because, in its appli- 
cation, no gland or part thereof is removed from its 
sphere of activity, no matter how abnormal its func- 
tion may be at any given time. 
Recapitulation: Dysthyroidism is a self-limited 
disease in which perverted function is the dominant 
feature and in which other endocrine glands play more 
or less important roles. Rational therapy should aim 
to carry the patient through the course of the disease 
with as little suffering and permanent disability as 
possible. Individualization is necessary in each case, 
and this is only possible through careful clinical observ- 
ation. Such intensive study of every case will progres- 
sively unravel the mysteries of thyroid dysfunction and 
thereby render its therapy more and more rational. 
BIBLIOGRAPHY 
1. McCaskey (G. W.): The differential diagnosis of 
hyperthyroidism by basal metabolism and alimen- 
tary hyperglycemia, N. York M. J., 1919, ex, 607. 
