164 THE THYROID, THE THYMUS, AND THE ADRENALS. 



we term "exophthalmic goiter" or "Graves's disease"; they have 

 been traced as pathological entities to their source: the supra- 

 renal glands. In other words, the thyroid gland merely sup- 

 plies a physiological stimulus to the adrenals that they need 

 to keep up their functions to the proper level. Having ascer- 

 tained that when this stimulation is excessive certain symp- 

 toms appear, we can conclude that, whenever they appear, they 

 invariably have the one and same origin: i.e., excessive supra- 

 renal activity. 



Again, we have ascertained, by analyzing the modus 

 operandi of thyroid extract in the treatment of exophthalmic 

 goiter, that the cases benefited could no longer be considered 

 as examples of suprarenal overstimulation, but, on the con- 

 trary, as cases of suprarenal insufficiency totally independent 

 of the thyroid glands. Indeed, it has become evident that some 

 cases of exophthalmic goiter are primarily due to inadequate 

 functional power of the adrenals, the unusual stimulus of even 

 an incipient case of Graves's disease inducing suprarenal insuffi- 

 ciency at a very early stage of the disease. This is doubtless 

 a compensative process which must greatly reduce the number 

 of instances among children, adolescents, and weaklings of all 

 kinds. We are thus normally led to the conclusion that: 



1. What we term exophthalmic goiter is a syndrome ascrib- 

 dble : 



(a) To overactivity of the adrenals, due primarily to ex- 

 cessive thyroidal secretion in the blood; then, in the second stage: 



(b) To insufficiency of the adrenals: i.e., when the excessive 

 thyroid secretion has induced their exhaustion or that of their 

 centers. 



2. All symptoms which have heretofore been directly or indi- 

 rectly ascribed, in this disease, to the thyroid gland should be 

 attributed to excessive or insufficient activity of the adrenals. 



Exophthalmic goiter has given us a general idea of the 

 phenomena brought on by suprarenal overactivity, but it af- 

 fords but a very limited expose of those of insufficiency. We 

 will, therefore, continue our analysis of the relationship be- 

 tween the thyroid and the adrenals through myxcedema and 

 cretinism (infantile myxcedema), the remaining general proc- 

 esses at present ascribed to the thyroid gland. 



