EXoi'iiriiM.Mic (;<)iii:i{ 607 



escaped from llic <:l;iii(l (lui-iiiii- the njx'i-at i\r iii;iiii|Mil;it ion. Tlic fact 

 tliat (i))ibli/(jpi(i, r('S('iiil)liii<z- that prodiK-ctl hy tol)acc(), etc., may follow 

 overuse of thyroid preparations ''■' is also indicative of their toxicity, as 

 also is the glycosuria that may i-esult from thyroid administration.*"'' 



Even if the hypotlie.sis that ex()])hthalmic goiter is due to intoxi- 

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

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

 cases deji'enerative 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 i)rod- 

 ucts of intestinal putrefaction, leading to a secondary hyperplasia of 

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

 things considered, it seems most probable that the hyperactivity of 

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

 primar3% 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 dia- 

 betes or pancreatitis have been associated,"" and some observers state 

 that the pressor substance (presumably epinephrin) in the blood is 

 much increased in exophthalmic goiter.''^ 



The Relation of the Parathyroids to Exophthalmic Goiter. — 

 This has not yet been definitely established. As nervous manifesta- 

 tions are very prominent after parathyroidectomy, so that many ex- 

 perimenters attribute all the acute nervous and muscular symptoms 

 of total thyroidecton\y to simultaneous removal of the parathyroids, 

 it has seemed very probable that these organs may be more closely asso- 

 ciated with exophthalmic goiter than is the thyroid itself."- Against 

 the hypothesis that exophthalmic goiter is due to parathyroid insuf- 

 ficiency, however, stand the following facts : 



(1) Kemoval of one lobe of the thyroid often causes improvement 

 or recovery in this disease, yet with the lobe of the thyroid is gener- 

 ally removed the adjacent parathyroid, which would decrease the 

 amount of parathyroid tissue, and make worse any existing parathy- 

 roid insufficiency. (2) Therapeutic administration of parathyroid 



S9 Birch-Hirsclifeld and Inouve, Graofe's Aroli.. inOo (til), 4nn. 



89b See Geyelin, Arch. Int. Med., 1915 ( 16), 97o. 



S9a The serum of patients with exophthalmic ofoiter sliows by Ahdcrhalden's 

 method a constant power to digest tliyroid tissue, and sometimes ovarv or testich^ 

 (Lampe and Fuchs. Miihch. med. Wo'ch., 1913 (BO), No. 39). 



90 Thompson, Amer. -lour. Med. Sci., 1906 (132), 835; Cohn and Peiser. Deut. 

 med. Woch., 1912 (3S), 60. 



91 Brokinjr and Trcndelonbiirnr. Dent. Arch. klin. Med., 1911 (103), 168. 



92 This subject is tliorouphlv reviewed by MacCallum, Med. News, 1903 (83), 

 820; Iversen,'Arch. Internat. de C'hir., 1914 (6), 255. 



