MYXEDEMA AND CRETINISM (i07 



the causes of colloid goiter and paieiicliymatous goiter will be found 

 to be different from the causes of cystic and adenomatous goiters. 



Myxedema and Cretinism 



These conditions depend upon a deficiency of thyroid secretion, 

 whether from operative procedure or from pathological alterations in 

 the organ. Consequently we find evidences of a decreased protein 

 metabolism, the urine containing a diminislKMl quantity of nitrogen, 

 especially in the form of urea, while ammonia and other forms of 

 nitrogen are relatively excessive. A retention of nitrogen and phos- 

 phorus has been found, but not of calcium and chlorine.'^'* The 

 temperature is usually subnormal, and thcenergy metabolism is low. ^* 

 Basal metabolism is lower than in any other known condition (Du 

 Bois).'^° Fat and carbohj-drate metabolism seem not to be propor- 

 tionately affected, ^^ and hence the elimination of CO2 is relatively high 

 as compared to the nitrogen elimination. , Gastro-intestinal disturb- 

 ances are common, with resulting increase in the amount of indican 

 and ethereal sulphates in the urine. Whether from this cause or 

 from deep-seated metabolic anomalies, there is a decided anemia, and 

 the ability of the corpuscles to combine with oxygen seems to be 

 decreased, so that the arterial blood may contain less oxygen than 

 normal venous blood. It is impossible to say whether the failure of 

 growth and development of the young (cretinism), and the mental 

 and physical torpidity of the adult, are due to an autointoxication from 

 products of intermediary metabolism which accumulate because of the 

 failure of the thyroid to furnish the "stimulus" necessary for their 

 complete destruction, or to a lack of some essential action of the thy- 

 roid secretion upon the nervous tissues and the growing cells them- 

 selves. Administration of thyroid extract to cretinoid children causes 

 retention of nitrogen and phosphorus, but more strikingly of cal- 

 cium,"- and obese cretins lose weight, chiefly from the non-nitrogenous 

 elements (Scholz). The amount of iodin in human cretin thyroids 

 seems not to have been estimated, but in five cretin dogs Marine and 

 Lenhart could find no thyroid iodin at all." 



The myxedematous change in the connective tissues is in the nature 

 of a reversion to the fetal type of tissue, and suggests that the thyroid 



68 Benjamin and Reuss, Jahrb. f. Kinderheilk., 1908 (67), 261. In a cretin 

 Greenwald found little deviation from normal. (Arch. Int. Med., 1914 (14), 

 374.) 



«9 Talbot, Amer. Jour. Dis. Chil., 1916 (12), 145. 



"0 Arch. Int. Med., 1916 (17), 915; Means and Aub., ibid., 1919 (24), 404. 



" Rarely myxedema and diabetes have been observed conjointly (see Strasser, 

 Jour. Amer. Med. Assoc, 1906 (44), 765). 



" See Hougardy and Langstein, Zeit. f. Kinderheilk., 1905 (61), 633. Full 

 figures are given by Scholz, Zeit. exp. Path. u. Thcr., 1906 (2), 270. 



" Related to cretinism is the "hairless pig malady," in which hairless pigs are 

 born dead or die soon after birth, the mothers and offspring often having goiter; 

 administration of KI checks the appearance of the disease (See Hart and^Steen- 

 bock. Jour. Biol. Chem.,.1918 (33), 313). 



