CONTRIBUTION TO PATHOLOGY OF EXOPHTHALMIC GOITRE 5 



one to infer a corresponding difference in the pathology of the two 

 affections, for while the condition of the gland in Graves' disease is most 

 likely one of hypertrophy and increased functional activity, that pre- 

 vailing in myxoedema is undoubtedly one of atrophy, with corresponding 

 loss of function. The beneficial results following immediately upon 

 operative procedures for the removal of portions of the hyperactive 

 thyroid tissue also support this view, namely, that the disease is probably 

 due to over-secretion. 



Further, the condition of thyroid^m, produced by over-dosing with 

 thyroid extract, resembles Graves' disease in many of its symptoms. 



As just remarked, the secretion of the exophthalmic thyroid is in all 

 probability not normal colloid. The microscopic appearances of the 

 material in the vesicles are certainly not those of normal secretion. 

 Granted that there is an increased functional activity of the glandular 

 tissue, as the character of the lining epithelium of the vesicles and the 

 analogy with the changes seen in compensatory hypertrophy would seem 

 to indicate, then the scantiness of the colloid contents of the alveoli most 

 Hkely would point to a rapid and extensive absorption of this altered 

 secretion, and its absorption might account for the varied nervous and 

 other symptoms of the disease. The pathological changes discovered in 

 the central nervous system and sympathetic might also be due to this 

 cause ; they appear to resemble the lesions known to be the result of 

 toxic poisoning. 



The following account of the condition of parts found in the 

 thyroid gland and elsewhere, is founded upon the examination of three 

 instances of the disease. In Case i, permission was fortunately obtained 

 for a complete post mortem examination. The portions of gland 

 in the two other cases were excised during life ; that described under 

 Case 2 is particularly interesting, as illustrating the changes which had 

 taken place nearly two years after operation. 



Case 1. 



This case was the only one which afforded opportunity for a complete 

 post mortem examination. The patient was a young girl, aged 16, who 

 had suffered for about two years from all the typical clinical features of 

 exophthalmic goitre. She died very suddenly after over-exertion, 



(203) 



