EXOPHTHALMIC GOITER 609 



strated." Levin" states tliat mucin is toxic for thyroidcctomized 

 rabbits, but this is not substantiated by N6f<5diefT." 



That the thyroid is connected witli general growth is shown not 

 only by the thyroid abnormalities present in cretinism, but also by 

 the frequent observation of thyroid defects in conditions of delayed 

 growth and development of less extreme degree {infantilism) , and the 

 favorable effects of thyroid feeding in many such cases. Also in cer- 

 tain types of short-limbed dwarfs (chondrodystrophia Jodnlis) some 

 thyroid anomaly maj^ have an etiologic bearing, for in such a case, in 

 which the thyroid was histologically greatly altered and quite free 

 from colloid, I could find no trace of iodin.*" On the other hand, the 

 thyroid of a giant which I have analyzed contained 62.9 mg. of iodin, 

 or six times the amount present in normal glands.*' 



Exophthalmic Goiter 



It has by no means been conclusively determined that exophthalmic 

 goiter is due to an intoxication with excessive amounts of thyroid se- 

 cretion, either normal or abnormal, but there is abundant evidence in 

 favor of this view. Most important is the similarity of exophthalmic 

 goiter to the effects of "hyperthyroidism" or "thyroidismus," pro- 

 duced either experimentally or through overuse of thyroid extract for 

 therapeutic purposes. In thyroidismus there are observed a rapid, 

 weak pulse; greatly increased metabolism, especially of proteins ;^2 

 a strildng increase in basal metabolism, paralleling the degree of 

 intoxication; marked mineral loss, especially of Ca and P from the 

 bones ;^^ increased secretion, especially of perspiration; marked ner- 

 vousness and irritability, often with mental confusion and delusions; 

 gastro-intestinal disturbances, especially diarrhea; sweating, flushing, 

 tremors, palpitation of the heart, loss of weight, and slightly increased 

 temperature are also often observed, and not rarely typical exoph- 

 thalmos may appear.*'* These manifestations, which are common to 

 both thyroidism and to exophthalmic goiter, are quite the opposite of 

 the characteristic changes of myxedema, w4th its general lowering of 

 all metabolic and nervous processes. Alike in experiniental hyperth}-- 

 roidism and exophthalmic goiter there is a greatly increased sensitive- 

 ness of the sympathetic nervous system to epinephrine.** Reid Hunt's 



" See Parhon, Compt. Rend. Soc. Biol., 1916 (79), 504. 



^8 Med. Record, 1900 (57), 184. 



" Vratch, 1901 (22), Oct. 27. 



80 Reported bv Hektoen, Amer. Jour. Med. Sci., 1903 (125), 751. 



«i Reported by Bassoe, Trans. Chicago Path. Soc, 1903 (5), 231. 



^- Metabolism in exophthalmic goiter, see Du Bois, Arch. Int. Med., 1916 (17), 

 915: Halverson, Bergeim and Hawk, ibid., 1916 (18), 800; Meaas and Aub, Arch. 

 Int. Med., 1919 (24), 645. 



83 Kummer, Rev. M6d. Suisse Rom., 1917 (55), 442. 



*^ Sugar utilization is decreased, as shown by study of the utilization of 

 sugar given intravenously (\Vilder and Sansum, Arch. Int. Med., 1917 (19), 311) : 

 also a dietary hvperglucemia is readily induced (Denis, Aub and Minot. Arch. 

 Int. Med., 1917 (20), 964; McCaskv, Jour. Amer. Med. Assoc, 1919 (73), 243). 



85 See Goettsch, N. Y. State Jour. Med., July, 1918. 



39 



