THE THYROID-OVARIAN SYNDROME 109 



should be reduced one half, but it must be kept up con- 

 stantly for a period of from three to six months in 

 order to have the relief continuous. After the six 

 months' period medication may be reduced to approxi- 

 mately one quarter of the intensive dose, and it need 

 only be given intermittently, say, for two to three days 

 in the week this, however, must be continued either 

 indefinitely or for very long periods. 



It goes without saying that the treatment outlined 

 is not a matter of rule of thumb, judgment must be used 

 particularly in the administration of the thyroid. A 

 rise in the pulse rate, the rapid loss of weight, 

 diarrhea and the development of nervousness are all 

 indications of toxemia and indicate the need for less 

 intensive dosage. When the normal weight has been 

 established it is well to allow a further reduction of five 

 pounds and then endeavor to hold it at that figure. 

 While occasionally the administration of a single gland 

 may prove to be effectual, such cases are, in the experi- 

 ence of everyone, relatively rare. Success is much more 

 uniform when the various glands are combined accord- 

 ing to the scheme indicated. The criticism may be 

 made that a so-called "shotgun" therapy is advocated, 

 however, it is "shotgun" therapy only to those who do 

 not understand the altered physiology upon which it is 

 based. 



In the body of the article we have purposely re- 

 frained from discussing the work of others who have 

 considered one or another phase of the syndrome. For 

 those who may be interested, the recent literature per- 

 taining to the subject in its various phases is appended. 



BIBLIOGRAPHY 



1. Barrett (A. M.) : Hereditary occurrence of hypothy- 

 roidism with dystrophies of nails and hair, Arch. 

 N enrol. & Psychiat. (Chicago), 1919, ii, 628. 



