THYROID INSUFFICIENCY 185 



condition, and that suprarenin overcomes the dilatation Osteomal- 

 by producing vasoconstriction an effect that can equally a( 

 well be obtained by removing the source of the vaso- 

 dilating secretion, that is by oophorectomy. 



Further, Erdheim 1 has stated that with osteomalacia 

 hyperplasia of the parathyroids is found. If this be so, 

 it would appear that the hyperplasia of the parathyroids 

 represents an attempt on the part of these organs to 

 counteract the effects of an excessive ovarian secretion, 

 and thus lead to calcium retention, if indeed the 

 hyperplasia be greater than that seen normally in 

 pregnancy. 



Be this as it may, substitution of other extracts is a 

 great advance on removal of the ovaries in the treatment 

 of osteomalacia ; and the success thus obtained indicates 

 the line of attack that will probably be followed in the 

 future in regard to all those diseases of the hormono- 

 poietic glands in which there is an excessive secretion ; 

 that is to say, metabolically antagonistic extracts will 

 take the place of removal of portions of the affected 

 organs. 



Disturbances of the Thyroid Secretion 



Absence and Insufficiency of Secretion. Absence Absence and 

 of thyroid secretion is, of course, extremely rare, and can oTthyroid 05 

 only be seen in the congenital cretins. In these circum- secretlon - 

 stances there is an absence of the onset of puberty, 

 should the patient live to that period of life. A case of 

 this character has already been described (p. 157). 

 Although the genital organs were well developed it 

 appears that they were unable to functionate in the 

 absence of thyroid secretion. 



With thyroid insufficiency there is usually a decrease Thyroid 

 in, or the complete cessation of, the function of menstrua- 

 tion, according to the degree of insufficiency. We 

 have already seen that considerable atrophy is found 



1 Erdheim, J., Sitz. der Akad. d. Wiss. Math, naturw. KL,Wien, 

 1907, cxvi, 3 Alt., p. 311. 



