134 THE INTERNAL SECRETIONS 1920 



to take only one capsule a day. She has gained a 

 pound a week since the dosage was reduced, and now, 

 5 months after beginning treatment, writes that she is 

 in better health than she has been in four years and 

 considers herself cured. 



CONCLUSIONS 



1. In this series of 75 cases only three patients could 

 not tolerate one twelfth grain of thyroid extract (U. S. 

 P.) daily. Two of these were severe exophthalmics in 

 whom probably I had not destroyed enough of the thy- 

 roid and the third patient was a neurasthenic with no 

 thyroid enlargement or symptoms of hyperthyroidism. 

 She was inclined to obesity and ran a subnormal tem- 

 perature. One twelfth grain of thyroid was sufficient 

 to produce a headache that would last twelve to twenty- 

 four hours. This last individual is probably a case 

 of thyroid idiosyncrasy. 



2. It is believed that the administration of thyroid 

 after partial thyroidectomy or destructioin of a portion 

 of the thyroid by injection, will lessen the tendency of 

 these patients to develop recurrence, which is probably 

 due to secondary compensatory hypertrophy and hyper- 

 plasia of the untreated thyroid. 



3. I believe that the product of the anterior pituitary 

 lobe gives better results in the after treatment of toxic 

 goitre than the posterior pituitary principle. 



4. Thymus is recommended by several writers as 

 having a beneficial effect in hyperthyroidism and the 

 presence of one grain of the desiccated gland in this 

 formula evidently adds to its value in these cases. 



5. Generally speaking the best results will be secured 

 by giving all ductless gland extracts over a period of 

 six to twelve months. 



6. If the symptoms of a patient with toxic goitre are 

 aggravated, even following small dosage, or if she loses 

 weight under anterior pituitary and thyroid, it is evi- 



