134 THE INTERNAL SECRETIONS—1920 
to take only one capsule a day. She has gained a 
pound a week since the dosage was reduced, and now, 
5 months after beginning treatment, writes that she is 
in better health than she has been in four years and 
considers herself cured. 
CONCLUSIONS 
1. In this series of 75 cases only three patients could 
not tolerate one twelfth grain of thyroid extract (U.S. 
P.) daily. Two of these were severe exophthalmics in 
whom probably I had not destroyed enough of the thy- 
roid and the third patient was a neurasthenic with no 
thyroid enlargement or symptoms of hyperthyroidism. 
She was inclined to obesity and ran a subnormal tem- 
perature. One twelfth grain of thyroid was sufficient 
to produce a headache that would last twelve to twenty- 
four hours. This last individual is probably a case 
of thyroid idiosyncrasy. 
2. It is believed that the administration of thyroid 
after partial thyroidectomy or destructioin of a portion 
of the thyroid by injection, will lessen the tendency of 
these patients to develop recurrence, which is probably 
due to secondary compensatory hypertrophy and hyper- 
plasia of the untreated thyroid. 
3. I believe that the product of the anterior pituitary 
lobe gives better results in the after treatment of toxic 
goitre than the posterior pituitary principle. 
4. Thymus is recommended by several writers as 
having a beneficial effect in hyperthyroidism and the 
presence of one grain of the desiccated gland in this 
formula evidently adds to its value in these cases. 
5. Generally speaking the best results will be secured 
by giving all ductless gland extracts over a period of 
six to twelve months. 
6. Ifthe symptoms of a patient with toxic goitre are 
aggravated, even following small dosage, or if she loses 
weight under anterior pituitary and thyroid, it is evi- 
