A Contribution to the Pathology of Exophthalmic Goitre, 



The pathology of exophthalmic goitre, despite the extensive 

 researches which have been carried out upon the subject, still remains 

 somewhat obscure, although the bulk of the evidence would appear to 

 point to a primary thyroidal origin. 



The theories which have been advanced from time to time with 

 regard to the pathology of this disease may be roughly classified under 

 the three following headings: — (i) The thyroid theory. (2) The 

 central nervous theory. (3) The cervical sympathetic theory. 



It is very difficult to explain the various symptoms of Graves' 

 disease upon a purely nervous origin, although many of them can be 

 reproduced experimentally by lesions inflicted upon the great nerve 

 centres. Filehne and Bienfait (Bull. Acad. roy. de med. de Belg., 

 Bruxelles, 1890) were able to imitate certain of the symptoms of the 

 disease by lesions made experimentally upon the restiform body. 



Mendel (Deutsche med. Wochenschrift, Feb., 1892) has recorded a 

 case of Graves' disease in which atrophy of the restiform body was 

 found after death. 



Nor can lesion of the sympathetic system, whether irritative or 

 paralytic, explain all the various phenomena. Schiff, who destroyed the 

 sympathetic nerve fibres accompanying the blood vessels of one lobe of 

 the thyroid gland in the dog, found that both lobes remained identical 

 in structure. 



The post mortem appearances found in the nervous system have been 

 extremely inconsistent and irregular, and have resembled in many cases 

 those produced by toxic influences. Clinically, however, there would 

 appear to be a very intimate connection with the central nervous system : 

 the frequent development of emotional disturbances throughout the 

 course of the malady has from the first been recognised. Sudden 

 nervous influences, such as shock, moreover, have a very marked effect 



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