604 CHEMICAL I'ATIIOLOGY OF THE DUCTLESS GLAyOS 



■\\iiicli The thyroid was liistolo^ically 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 liave analyzed contained 62.9 mg. of iodin, 

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



EXOPHTHALMIC GOITER 



It lias 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. IMost 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 thyroidisnuis there are observed a rapid, 

 Aveak pulse ; greatly increased metabolism, especially of proteins ; ^^ 

 increased secretion, especially of perspiration; marked nervousness 

 and irrital)ility, often with mental confusion and delusions; gastro- 

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

 ors, 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, with its general lowering of 

 all metabolic and nervous processes. Reid Hunt 's 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 re- 

 semble 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 in- 

 crease in the mitochondria of the thyroid epithelium in exophthalmic 

 goiter, which also is evidence of heightened activity.'*-'' 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 tliyro- 

 iodin 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 



Ti Reported by Hektoen, Amer. Jour. :\I("(1. Sci., 1003 (125), 7.>1. 



"2 Reported by Bassoe, Trans. Cliicufio I'atli. Soe., 1!)()3 (;1), 2'M. 



"•■''Metabolism in exopiitlialniic j^oiter, see Du ]?ois, Areli. Int. Mi'd., l!'l(i (17), 

 *»l;i: llalverson, l?er-,reini and Hawk, ihid., 1010 (IS), 800. 



T.jii Sufrar niilizat ion is decreased, as sliown by study of tlie utiii/ation of 

 suffar {liven intravenously (\^'ilder and Sansuni, Areh. Int. 'Nted., 1017 (10), 311). 



T4See Gliedini, Wien." klin. Woeli., 1011 (-24), 73lJ: Hunt and Seidell, .lour. 

 Pharm. and Exp. Tlier., 1010 (2), 1.5. 



7-«aCoet8eh, Bull. Johns ITojjkins Tlosp., 101(1 (27), 120. 



■!^ Dent. Zeit. Chir.. 1008 (01), .302. 



