DYSTHYROIDISM 115 



The immediate results afford some relief to the pa- 

 tient, but it is difficult to say exactly how much it is 

 necessary to remove in order to restore normal func- 

 tion. When symptoms do not abate, a second operation 

 with removal of more thyroid tissue is frequently re- 

 sorted to. (Sloan, 5 Beebe 6 ) . The other extreme, oper- 

 ative myxedema, is an infrequent subsequent develop- 

 ment at the present time. 



Although improvement is the general rule following 

 lobectomy, a complete and immediate cure is rarely the 

 case. (Bram 7 ). Surgery does not remove the cause, 

 but rather the result of abnormal function. It is a dif- 

 ference in degree only between this operation and that 

 of removing the superior cervical sympathetic ganglion 

 (Mayo 8 ) for the cure of exophthalmos, an occasional 

 symptom of dysthyroidism. 



Clinicians and surgeons both have come to recognize 

 that dysthyroidism is a self-limited disease which runs 

 its course and goes on to recovery (Stanton 9 ). This 

 being true, operative procedures merely modify the 

 course and do not effect a cure. 



Thyroidectomy in this instance is comparable to 

 splenectomy in pernicious anemia. In the latter case a 

 remission is frequently produced, but the general course 

 of the disease is but slightly altered and a fatal termi- 

 nation is the inevitable outcome. 



This conception of thyroid conditions explains the 

 lack of uniformly good results after sub-total thyroid- 

 ectomy. The reduction of thyrotoxic symptoms will 

 vary with the stage of the disease present when oper- 

 ation is performed. Those cases which continue to 

 show signs of increased activity after operation are 

 considered by surgeons as having had an insufficient 

 amount of gland tissue removed. But more probably 

 the disease had yet to run a portion of its course and 

 lobectomy at that time had a less noticeable influence 

 than the same operation done later. The following 



