58 THE DISEASES OF THE THYROID GLAND 



were present exophthalmus and a struma, which microscopically gave a 

 picture very similar to that of a typical Basedow's struma. Familial oc- 

 currence of Basedow's disease is not at all uncommon. E. Frey reports a 

 family of five persons, of whom four suffered with Basedow's disease. Oster- 

 reich reports likewise a family in which ten members were affected with 

 Basedow's disease. In the familial type we find not rarely many mitigated 

 hyperthyroses or hypothyroses. In addition occur neuroses of the vegeta- 

 tive nervous system, diabetes mellitus, and even psychoses. Grober publishes 

 the family tree of such a family. 



Finally it should be stated that the disease is met with in animals (dogs, 

 cows, horses), in isolated cases. 



Symptomatology. The pathologic alteration may develop in a pre- 

 viously normal thyroid gland or in a thyroid gland degenerated into a goiter. 

 The thyroid gland increases in volume, becomes soft and elastic, through 

 dilatation of the blood-vessels, and becomes very vascular through new 

 formation of blood-vessels; under circumstances it shows expansive pulsa- 

 tions and frequently also variations in volume, paralleling the phenomena 

 of Basedow's disease; in many cases the apparently not enlarged thyroid 

 may become palpable through voluntary increase of the intrathoracic pres- 

 sure (Fr. Kraus) . In acute cases the swelling of the thyroid may appear over 

 night and even lead to difficulty in breathing. It can subside just as sud- 

 denly (Trousseau, Mobius, et al.). On the application of a stethoscope ap- 

 plied to the gland, we can for the most part hear vascular murmurs 

 synchronous with the heart action (Guttmann) . The hand laid on the gland 

 feels a distinct thrill; we can diminish the size of the gland by pressure. 

 The enlargement of the gland is a very common symptom, yet there certainly 

 do occur cases with distinct manifestation of hyperthyrosis, in which the 

 enlargement of the thyroid gland is barely demonstrable. With longer 

 duration of the disease, the consistence of the gland becomes firmer. 



The microscopical examination shows, in addition to increased vasculariza- 

 tion, rich new formation of epithelial plugs and of glandular acini which later 

 are often well filled with desquamated cells; in addition there are accumu- 

 lations of lymphoid cells (Gibson, Greenfeldt, F. Mtiller, Lubarsch, et al.), 

 Other authors (Farner and others) find less typical alterations, although 

 A skanazy points out correctly that the aberrant findings come from goiter 

 districts ; it may therefore be assumed that in these cases the alterations of 

 Basedow's have developed in thyroids that are already degenerated. Kocher 

 designates the typical Basedow struma as a struma hyperplastica paren- 

 chymatosa telangiectodes; it ordinarily contains no colloid, and for the most 

 part is poor in iodine. 



Among the cardiovascular symptoms, tachycardia stands in the fore- 

 ground. For the most part there exists in addition an especial lability of 

 the pulse. It may happen that on complete rest the pulse lies only slightly 



