DYSTHYROIDISM 119 



perature to 105, delirium, marked leukopenia and cya- 

 nosis. She made an uneventful recovery but two 

 months later began losing weight, became dyspneic, 

 had spells of weakness and palpitation, developed a 

 tremor and showed further increase in the thyroid en- 

 largement with tachycardia and slight exophthalmos. 

 The condition was obviously due to the thyroid, so she 

 was put to bed, given some sedatives and a protein low 

 diet. The pulse dropped from 112 to 72 in seven weeks 

 and she improved in every respect, both subjectively 

 and objectively. 



Believing a casual relation existed between the in- 

 fluenzal infection and the abnormal thyroid activity, 

 her condition was considered to be one which would 

 subside in time and operation was advised against. 



Boeder 15 reports eight cases following influenza, 

 three of which resembled this one, in that the patients 

 had adenomata, which suddenly became very toxic. 

 This relation of thyroid dysfunction to influenza was 

 noted in the epidemic of 1890 by Hale-White, 16 who 

 mentions having seen three such cases. Todd 17 reports 

 sixteen cases of hyperthyroidism, which developed sud- 

 denly during the convalescence of fifteen hundred pa- 

 tients from influenza. 



The literature abounds in reports of cure or improve- 

 ment in thyroid cases after removal of focal infections, 

 chiefly located about the oral cavity. (Pern, 18 Reede, 19 

 Bergh 20 ). Sloane 5 reports five cases of symptoms re- 

 curring after operation, which did not improve until 

 the focal infections existing in the patients were re- 

 moved. 



Those cases of dysthyroidism developing during 

 puberty or the menopause are most obviously ones 

 which can be expected to run a definite course and then 

 subside. Thyroid activity is a part of the general read- 

 justment of the whole endocrine system. Such cases 

 obviously should be given medical treatment as long as 



