INFLAMMATION 55 



especially frequent, especially in the bones of the skull and in the sternum; 

 in sarcoma, metastases are frequently found in the lung. The metastases 

 of adenocarcinoma of the thyroid gland contain not inappreciable amounts 

 of iodine. Gierke reports two cases of carcinoma of the thyroid with metas- 

 tases in the vertebral column. In the case of Ewald, the highly decomposed 

 primary adenocarcinoma of the thyroid was iodine free; the metastases in 

 the lungs and lymph-glands contained iodine. The decision as to whether an 

 adenoma of the thyroid is malignant or benign is often very difficult (v. 

 Eiselsberg). Microscopically metastases may appear as gelatinous goiters, 

 and yet the very presence of metastases may in itself be regarded as the sign 

 of malignancy. Sometimes the metastases when examined microscopically 

 show a formation similar to carcinoma. 



On account of the proximity to many important organs (trachea, esopha- 

 gus, sympathetic, vagus, etc.), tumors of the thyroid not infrequently cause 

 very manifold local manifestations, which will not be discussed further at 

 this place. They may also give rise to alterations in the thyroid function. 

 Symptoms of deficiency [of secretion] are relatively rare, and it may then 

 happen that the symptoms of myxedema retrogress when metastases de- 

 velop (v. Eiselsberg) or when accessory thyroids begin to grow. This may 

 even occur when the metastases have become degenerated carcinomatously. 

 Indeed v. Eiselsberg found in the metastases in such a case follicles still filled 

 with colloid. Not so very rarely malignant tumors of the thyroid gland 

 take on the characteristics of Basedow's disease. Saltier has collected 

 sixteen such cases, of which eleven were carcinomata, and three sarcomata, 

 while in two the character was not determinable. Indeed the Basedow's 

 symptoms may not appear until just at the time that the metastases develop 

 (/. Lowy has collected the literature). We find therefore that malignantly 

 altered thyroid gland tissue may not only affect the normal function, but, 

 when proliferation is rapid, may even lead to hyperfunction. The inter- 

 pretation of the symptoms of Basedow's as hypothyrosis (Minnich) is not 

 to be regarded as correct. 



Inflammations of the Thyroid Gland. We distinguish between thyroi- 

 ditis and strumitis. The first is very much rarer, as apparently the normal 

 thyroid shows little tendency for inflammatory processes, which has also been 

 determined experimentally on animals. In thyroiditis, too, as Jeanseline 

 mentions, the termination in suppuration is much rarer. A light inflamma- 

 tion of the thyroid is very often an accessory phenomenon of acute infections 

 {Roger and Gamier, Kashiwamura, de Quervain, Sarbach, and others). The 

 histological alterations, which consist in epithelial desquamation and dis- 

 appearance of the follicles, hyperemia, etc., may be not inappreciable after 

 scarlet fever and variola, and also after other infectious diseases. Thyroiditis 

 is not uncommon in the early stages of syphilis (according to Engel-Remiers 

 in 56 per cent, of cases). Slight sclerotic processes are often present in 



