THYROID EXCESS 191 



for there is an excessive excretion of lime salts in this Hyper 

 disease, and consequently much danger of haemorrhage 

 post partum, and even ante partum. If no improvement nancy 

 follow this treatment infundibulin should be adminis- 

 tered. 



It may be mentioned here that some time ago I sug- 

 gested injections of pituitary extract in the treatment of 

 hyperthyroidism. Suprarenal and pituitary extracts 

 counterbalance the action of the ovaries and thyroid and 

 lead to calcium retention ; this, as we have already seen, 

 is a normal function of the suprarenals and pituitary. It 

 is probable that both portions of each of these organs 

 are concerned in the result. Infundibulin should, there- 

 fore, be given immediately after labour to all patients 

 with exophthalmic goitre, in order that by its direct 

 action on the musculature of the uterus bleeding may 

 be prevented. 



Whether pregnancy can cause exophthalmic goitre 

 has recently been debated. Equally eminent clinical 

 obstetricians have made diametrically opposed state- 

 ments. Personally, I do not feel competent to express 

 an opinion as to whether pregnancy can cause exophthal- 

 mic goitre, but I have certainly seen this disease arise 

 during pregnancy on several occasions. In one case, 

 contrary to expectation, the condition did not improve 

 after parturition. Marked improvement, however, was 

 effected by treatment with pituitary extract ; and when 

 the patient was last seen she had no evidence of the 

 disease beyond a somewhat rapid pulse and excitable 

 temperament. In another woman the exophthalmic 

 goitre commenced immediately subsequently to parturi- 

 tion and lactation, the latter being only possible for a few 

 weeks. I saw her eleven months after her confinement, 

 when there was amenorrhcea with superinvolution of 

 the uterus. This patient, who was treated with pituit- 

 ary extract, completely recovered, and menstruated 

 regularly from a uterus measuring 2J inches. After 

 the disappearance of all symptoms the pituitary 

 extract was discontinued ; but a fortnight later the 



