THE THYROID-OVARIAN SYNDROME 99 



anemia. Laboratory examinations : Urine faint trace 

 of albumen. Sp.gr. 1010 to 1014, few hyaline casts. 



CASES WITH INITIAL DYSTHYROIDISM 



The cases which commence with thyroid disturbances 

 first complain of a series of symptoms similar to those 

 usually associated with chronic nephritis. Frequently 

 the first symptom is a headache, which comes on early 

 in the morning, often awakening the patient from sleep 

 and lasting until midday. Dizziness and double vision 

 are also frequent occurrences. If the blood pressure be 

 taken at this period it will be found to be increased, in 

 some cases alarmingly so, 200 mm. of mercury being 

 not infrequent. This increase in blood pressure in 

 women at the menopause has been commented upon by 

 others. A gradual development of trophic or metabolic 

 disturbances follows. There is frequent complaint of 

 itching. The hands are described as feeling boggy and 

 stiff in the morning, finger rings being turned around 

 with difficulty then, and without difficulty later in the 

 day. There is a slight edema of the legs and the skin 

 feels puffy. 



Physical examination shows little or no change from 

 the normal. Occasionally the second aortic heart sound 

 is accentuated. Laboratory examinations for kidney 

 involvement are negative. Occasionally there are mild 

 or severe evidences of hyperf unction (4 of 16 cases) 

 with nervous irritability, and in one case glycosuria. 

 In two cases a temperature varying from 99.4 to 

 100.8 F. (per os) persisted for eighteen months to two 

 years without demonstrable cause. 



The onset of these symptoms is rather acute and they 

 last with varying severity from two to seven or eight 

 years. The skin during this period gradually becomes 

 drier; there is a marked gain in weight, averaging in 

 twenty-seven cases, 35 Ibs. ; the hair becomes brittle. 

 The types commencing as thyroid dysfunction usually 



