610 CHEMICAL PATHOLOGY OF THE DUCTLESS GLANDS 



acetonitrile test for thyroid secretion has been found positive in the 

 blood from patients with exophthalmic goiter, ^^ which presumably 

 means the presence of an excess of thyroid secretion circulating in the 

 blood in this disease. Furthermore, the histological changes observed 

 in the thyroid may resemble those of compensatory hypertrophy, 

 suggesting strongly that the goitrous change of this disease is due to a 

 true hypertrophy, with increased production of the specific secretions. 

 There is a marked increase in the mitochondria of the thyroid epithe- 

 lium in exophthalmic goiter, which also is evidence of heightened activ- 

 ity.^'' Kocher^^ says that when iodin is given to patients with cancer 

 of the thyroid they may develop symptoms of exophthalmic goiter, as 

 if an excess of thyroiodin were formed. Also speaking strongly in 

 favor of the view that exophthalmic goiter is the result of overactivity 

 of the thyroid, is the frequent cure of the disease through removal of a 

 large part of the diseased gland. Although at times the colloid type 

 of gland is found in exophthalmic goiter, Marine contends that it has 

 been preceded by a hyperplastic stage. ^^ 



Oswald^° found that the thyroid in exophthalmic goiter contains 

 generally a smaller proportion of iodin than normal glands, but with 

 the total amount approximately normal. However, the findings are 

 very inconstant, corresponding with the fact that in some cases of 

 exophthalmic goiter the amount of colloid is abundant (in which case 

 the amount of iodin may be large), while usually the amount of colloid 

 is small, and its highly vacuolated condition in hardened sections 

 suggests that it is of unusually fluid consistency. A. Kocher^^ found 

 that either the amount of iodin is small, which is usual, or else very 

 high, but it is seldom the same as in normal thyroids; the more dense 

 the colloid in the follicles the higher iodin content he observed; the 

 phosphorus content is both relatively and absolutely increased. Ma- 

 rine has found that in exophthalmic goiter as well as in other conditions 

 the amount of iodin is in direct proportion to the colloid and inverse 

 to the hyperplasia. E. V. Smith^- obtained in simple hyperplastic 

 glands an average of 0.54 mg. of iodin per gram dry weight, as com- 

 pared with 1.52 mg. in hyperplastic glands showing retrogressive 

 changes with more densely staining colloid. Fonio found that, as with 

 normal thyroids, the physiological effect of exophthalmic goiter glands 

 varies directly with the proportion of iodin, and such glands take up 

 iodin administered therapeutically just as a normal thyroid does 

 (Kocher,'-*^ Marine and Lenhart).^'* These results, therefore, indicate 



' 8" See Ghedini, Wien. klin. Woch., 1911 (24), 736; Hunt and Seidell, Jour. 

 Pharm. and Exp. Ther., 1910 (2), 15. 



8' Goetsch, Bull. .lohns Hopkins Hosp., 1910 (27), 129. 



88 Deut. Zeit. Chir., 1908 (91), 302. 



8» See also Wilson, Ainer. .Jour. Med. Sci., 1908 (136), 851. 



"o Virchow's Arch., 1902 (169), 475. 



"i Virchow's Arch., 1912 (208), 86. 



»2 Jour. Amer. Med. Assoc, 1914 (62), 113. 



»3 Arcli. klin. Chir., 1910 (92), 442; 1911 (96), 403. 



" Arch. Int. Med., 1911 (8), 265. 



