112 THE DISEASES OF THE THYROID GLAND 



observations, we should be cautious about bringing such alterations into 

 relationship with myxedema. 



The examination of the blood shows decrease of the red cells, and es- 

 pecially of the hemoglobin, the latter to 60 per cent, or even 40 per cent.; 

 also decrease in the dry residue and increased coagulability (Bultschenko and 

 Drinkmann, Kottman). The leucocytic formula is altered, consisting in 

 mononucleosis and mostly hypereosinophilia (Bence and Engel, and the 

 author) . 



In many cases are observed erythroblasts and slight poikilocytosis, 

 in others also Turk's irritation forms and myeloblasts. In one of the cases 

 herein quoted were found indeed isolated myeloblasts. Similar blood changes 

 are also found in thyroprivic animals (v. Eiselsberg, Zitschmann, Kishi, 

 Esser, Bertilli's investigations on our own dogs). The anemia quickly 

 ameliorates on the administration of thyroid-gland substance, and there 

 occurs a "paradoxical" reaction of the leucocytes, i.e., the leucocytic formula 

 approaches the normal, while in healthy individuals it is known that thy- 

 roidin produces mononucleosis (Falta, Newburgh, and Nobel}. More recent 

 investigations of Fonio agree with these; interruption of the thyroid-gland 

 therapy for the most part brings about a recurrence of the mononucleosis 

 (von Korczynski} , while the poverty in hemoglobin also is essentially amelio- 

 rated by the thyroid-gland therapy. 



The metabolism of myxedemics is reduced to a marked degree. We are 

 indebted to Magnus-Levy for the discovery of this. He found a reduction 

 of the fundamental exchange to 58 per cent. Treatment with thyroidin 

 brings the fundamental exchange to normal or supernormal figures. 



If the thyroid-gland therapy be interrupted, the amount of oxygen con- 

 sumed gradually sinks as the clinical symptoms recur. Also the twenty- 

 four-hour exchange is reduced, that is, myxedemics maintain an equilibrium 

 with a much less amount of calories and take on fat more readily than 

 does the normal individual. 



Sometimes accumulations of fat are found at entirely abnormal sites. 

 Thus Abrikosoff found in a fifty- two-year myxedematous woman accumula- 

 tions of fat in the lingual mucous membrane and in the submucosa of the 

 intestine. If myxedemics are nourished abundantly, the twenty-four-hour 

 exchange does not necessarily have to be below normal, and thyroidin 

 administration will then produce an enormous increase in the caloric pro- 

 duction. Steyrer found in his case an increase of 83 per cent, (investiga- 

 tion in Voit-Pettenkofer's apparatus) . Especially fat is concerned, while the 

 number of calories from protein is rather less than normal. Again, the pro- 

 tein exchange lies low, the protein requirements are light, and there may 

 be an addition of protein to the body. The relations in investigations as 

 to the hunger protein exchange are very clear. In thyroidless dogs we 

 found this distinctly reduced. 



