612 CHEMICAL PATHOLOGY OF THE DUCTLESS GLANDS 



Even if the hypothesis that exophthalmic goiter is due to intoxi- 

 cation with thyroid secretion is correct, we have no satisfactory ex- 

 planation of the cause of the hyperactivity of the thyroid. In some 

 cases degenerative changes have been observed in the superior cervical 

 sympathetic ganglia, and cure or improvement of exophthalmic goiter 

 is said to have followed resection of these ganglia; however, this re- 

 lation has not been observed at all constantly. In other cases there 

 has been evidence that suggested a primary intoxication with the prod- 

 ucts of intestinal putrefaction, leading to a secondar}^ hyperplasia of 

 the thyroid, but this also seems to be an exceptional observation. ° 

 All things considered, it seems most probable that the h3'^peractivity 

 of the thyroid is due to some exciting condition, and is not of itself 

 primary, although the resulting hypersecretion of the thyroid may 

 cause the dominant features of the disease. The frequent association 

 of exophthalmic goiter with puberty and pregnancy suggests that 

 some abnormality in the function of the generative organs may be a 

 frequent starting-point of the thyroid derangement. "^ In not a few 

 cases diabetes or pancreatitis have been associated,^ and some 

 observers state that the pressor substance (presumably epinephrine) 

 in the blood is much increased in exophthalmic goiter.^ Although 

 the thymus is often found enlarged, sometimes greatly so, in 70 to 80 

 per cent, of cases of exophthalmic goiter, its relation to the disease 

 is as yet entirely unknown.^ 



^ Antithyroid Serum. — Based on the theory that the normal function of the 

 thyroid is the detoxication of metabolic products, is the serum treatment advocated 

 first by Ballet and Enriquez, and later by Lanz, and Burghart and Rlumenthal. 

 (Deut. med. Woch., 1899 (25), 627. Also Mohius, Mlinch. med. Woch., 1901 

 (48), 1853; v. Leyden, Med. Klinik, 1904 (1), 1; Eulenberg, Bed. klin. Woch., 

 i905 (42), 3.) On the principle that after thyroidectomj' the blood should con- 

 tain an accumulation ot those substances, which the thyroid normalh' neutralizes, 

 they injected the serum of thyroidectomized goats into patients with exophthalmic 

 goiter, in the hope that these accumulated substances might m turn neutralize 

 any excessive thyroid secretion. Favorable results were obtained, and it was 

 subsequently found that the milk of thyroidectomized goats possesses the same 

 qualities, and may be administered by mouth; this has led to quite extensive 

 clinical use of this method of treatment, which has failed to show anj^ regular 

 beneficial effects in the hands of most careful observers. (See Sonne, Zeit. klin. 

 Med., 1914 (80), 229.) Of similar significance are the favorable etfects obtained 

 bv Beebe (Jour. Amer. Med. Assoc, 190a (40), 484; 1000 (47), 655) and Rogers 

 (ibid., 190G (46), 487; 1906 (47), 661) with a serum made by immunization of 

 animals with the nucleoproteins of the thyroid, which have not been corroborated 

 by others. 



* The serum of patients with exophthalmic goiter shows bj"- Abderhalden's 

 method a constant power to digest thyroid tissue, and sometimes ovarv or testicle 

 (Lampo and Fuchs, Miinch. med. Woch., 1913 (60), No. 39). 



^ Thompson, Amer. Jour. Med. Sci., 1906 (132), 835; Colin and Peiser, Deut. 

 med. Woch., 1912 (38), 60. 



8 Broking and Trendelenburg Deut. Arch. klin. Med., 1911 (103), 168. 



' Review by Eddy, Canad. Med. Assoc. Jour., March, 1919. 



