414 THE THYROID AND ADRENALS. 



DISTURBANCES OF CIRCULATION. 



Hypersemia of the thyroid gland, often accompanied by considerable 

 enlargement of the organ, may be the result of valvular disease of the 

 heart ; it occurs in Basedow's disease ; it may be temporary or perma- 

 nent, and in the latter case may be associated with the formation of new 

 connective tissue. Haemorrhages may occur, leading to pigmentation of 

 the organ. 



INFLAMMATION. (Strumitis.) 



Inflammation of the thyroid gland is not very common and may occur 

 under a variety of conditions. It may result in the formation of larger 

 and smaller abscesses or in the production of new connective tissue which 

 may be associated with atrophy of the parenchyma. Tuberculous inflam- 

 mation, with the formation of miliary tubercles, is of infrequent occur- 

 rence. ' Syphilitic inflammation, with the formation of gummata, has been 

 described, but is rare. 2 



STRUM A. (Hyperplasia of the Thyroid; Goitre.) 



Among the most important of the lesions of the thyroid is the 

 enlargement of the organ commonly known as the goitre or struma. The 

 enlargement of the gland may occur in several ways. Thus, a simple 

 hypersemia may, as above stated, lead to considerable enlargement of 

 the organ, and this is sometimes called struma hyperwmica. The true goi- 

 tre, however , consists in the enlargement of the old and the formation 

 of new gland alveoli, while with these changes there is very frequently 

 associated a greater or less amount of colloid degeneration. When there, 

 is new formation of gland tissue the growth has the character of an ade- 

 noma. The hyperplasia may occur diffusely, so that the whole gland is 

 more or less enlarged ; or it may occur in the form of circumscribed nod- 

 ules. When the colloid degeneration is prominent, so that the tunior 

 has a gelatinous appearance, it is called colloid struma (Fig. 215). 3 Ac- 

 cumulations of fluid, blood, colloid, etc., in the old or new-formed alveoli, 

 may lead to dilatation and atrophy of the walls of the alveoli, so that 

 cysts, sometimes of large size, are formed. Thus occurs the cystic struma. 

 Again, the blood-vessels may undergo marked dilatation, so that we may 

 have a telangiectatic struma; or, cavernous angiomata may form within 

 goitres. Very frequently all these varieties of lesions are present in the 

 same goitre. The appearances may be rendered still more complex by 

 the occurrence of haemorrhages and pigmentation, calcification, purulent 



1 See Roger and Gamier, Arch. gen. de Med., t. iii., p. 385, 1900, bibl. 



2 For a study of the normal and pathologic histology of the thyroid, with biblio- 

 graphy, consult Mutter, Ziegler's Beitr. z. path. Anat., etc., Bd. xix., p. 127, 1896; 

 also Erdheim, Ziegler's Beitr., Bd. xxxiii., 1903, p. 159. For myxcedema and Basedow's 

 disease, see pp. 331 and 332. 



3 For a consideration of the nature of colloid and its formation in struma see Rein- 

 bach, Ziegler's Beitr. z. path. Anat., etc., Bd. xvi., p. 596, bibl. 



