56 THE DISEASES OF THE THYROID GLAND 



tuberculosis and in severe alcoholism. Severe inflammatory processes in 

 the thyroid have been observed after typhoid fever, variola, influenza, 

 malaria, puerperal processes, etc. ; especially, however, after angina and acute 

 articular rheumatism. A detailed summary of the literature is that by de 

 Querv'ain. . The primary form of acute thyroiditis which does not go on to 

 suppuration, was first described by Mygind and more recently by de Quervain 

 in a very thorough report. The onset for the most part is sudden; with 

 evident general symptoms and fever the thyroid gland becomes swollen, 

 and there may be local symptoms of pressure. This is followed by severe 

 pains radiating to the ear and throat; the climax of the clinical mani- 

 festations is for the most part soon reached, and quickly, or more or 

 less slowly (lytically), all phenomena subside. The histologic picture of 

 the thyroid gland is in many respects similar to that of the Basedow thyroid. 

 Nothing is known as yet as to the causative agent. De Quervain recommends 

 quinine and salicylic acid for treatment; we must operate only when distinct 

 fluctuation is present. 



Not infrequently the inflammations of the thyroid gland lead to pro- 

 nounced disturbances of function. In a case of Reinhold's symptoms of 

 Basedow's appeared after influenza, and in a case of Gilbert and Gastaigne's 

 in the convalescence of typhoid fever. Worth mentioning is a case of de 

 Quervain's with recurring articular rheumatism and parallel symptoms of 

 a slight thyroiditis and a Basedow's. Apelt reports a case of suppurative 

 inflammation of a goiter of the tongue; after three days a thyroiditis made 

 its appearance, to give rise to a Basedow's which later disappeared almost 

 entirely. Also the clinical primary forms may be associated with similar 

 manifestations. In a case of Breuer's a typical Basedow's developed imme- 

 diately after an acute thyroiditis. As Mobius has already pointed out, we 

 cannot deny for these observations a certain significance in the pathogenesis 

 of Basedow's disease. 



Chronic inflammatory sclerosing processes commonly lead to myxedema 

 (see later). 



I may not leave unmentioned that administration of iodine serves to 

 increase the acute thyroiditis (Dunger). In the case of Himmelheber the 

 thyroiditis appeared immediately after a gynecologic operation; Himmelheber 

 ascribed to the iodine absorbed from the iodine catgut; after high fever, 

 tachycardia, acute cardiac dilatation, and delirium, the thyroid swelling 

 rapidly disappeared. 



The second group of diseases, those in which the internal secretory activity 

 of the thyroid gland stands in the foreground, may be divided into diseases 

 associated with increase of function and those with diminution or lack 

 of function. I begin with the first, as they are better adapted to give an 

 idea of the normal function of the thyroid gland. 



