EXOl'UTllALMIC GOITER (ill 



nothing cither for or ajrainst the hypothesis that cxoi)hthalmic goiter 

 is due to autointoxication with the secretion of the tliyroid, but Wilson 

 and KendalP-^ find that in the toxic type of goiters there is but Ho- 

 }i5 as much of the active iodin compound of Kendall as in normal 

 glands, and hence they suggest that in thyroid intoxication this toxic 

 material has been discharged from the thyroid into the circulation. 



On the other hand, it is impossible to produce a symptom-complex 

 completely resembhng exophthalmic goiter'-"' in animals by excessive 

 feeding of thyroid," either normal or from exophthalmic goiter; and 

 after extensive study of the subject Marine and Lenharthave come to 

 the conclusion that "the essential phj'siological disturbance of the 

 thyroid in exophthalmic goiter is insufficiency, its reaction com- 

 pensatory and its significance symptomatic." This view, however, 

 certainly fails to agree with the excellent results which come from 

 partial extirpation of the thyroid in exophthalmic goiter. Oswald, ^^ 

 also an experienced investigator in this field, invokes an abnormally 

 irritable nervous system, which stimulates the thyroid and in turn is 

 stimulated by the thyroid secretion, constituting a vicious circle. 

 Other observers are of the opinion that not an excessive, but a per- 

 verted, secretion is at fault, ^' a view not confirmed by tests of the 

 effects of thyroid extracts on animals.^ However, it is stated by 

 Blackford and Sanford,^ that extracts of the thyroid in this disease, as 

 well as the blood of patients in the acute toxic stages, exhibit a marked 

 depressor effect on blood pressure, which is distinct from that of 

 chohne, and which they believe to be specific for exophthalmic goiter. 



There can be no doubt that the thyroid secretion is capable of caus- 

 ing serious intoxication, for patients who have overused thyroid prep- 

 arations in the treatment of obesity, skin diseases, etc., have often 

 suffered severely from the symptoms mentioned previously, and, in at 

 least one such case, a diagnosis of exophthalmic goiter was made be- 

 fore the cause of the disturbance was detected. Not infrequently 

 evidences of acute intoxication have followed immediately after 

 operations upon the thyroid, and these have been considered as due to 

 intoxication with the large quantities of thyroid secretion that have 

 escaped from the gland during the operative manipulation. The fact 

 that amhlyopia, resembling that produced by tobacco, etc., may follow 

 overuse of thyroid preparations^ is indicative of their toxicity', as 

 also is the glycosuria that may result from thyroid administration.^ 



95 Amer. Jour. Med. Sci., 1916 (151), 79. 



9^ The pathogenesis of the exophthalmos is unknown. See Troell, Arch. Int. 

 Med., 1916 (17), 382. 



" See Carlson et al, Amer. Jour. Physiol., 1912 (30), 129; Marine, Jour. Amer. 

 Med. Assoc, 1912 (59), 325. 



5* Correspondenzblatt Schweizer Aerzte, 1912 (42), 1130. 



99 Klose et al, Beitr. z. klin. Chir., 1912 (77), 601. 



1 See Schonborn, Arch. exp. Path. u. Pharm., 1909 (60), 390. 



2 Jour. .\mer. Med. Assoc, 1914 (62), 117. 



3 Birch-Hirschfeld and Inouve, Graefe's Arch., 1905 (61), 499. 

 ^See Geyelin, .\rch. Int. Med., 1915 (16), 975. 



