MYXEDEMA 113 



The time consumed in the protein destruction in thyroidless dogs is, 

 according to the investigations of Pari, not altered. Administration of 

 thyroidin leads, in the wake of the consumption of myxedematous tissue, at 

 first to a significant increase of the nitrogen excretion, this giving place to 

 normal relations. The relations of the salt metabolism in myxedemics is 

 not as yet fully explained; it is to be expected that the need for salt is slighter 

 and that less calcium is cast off in the feces, as the administration of thy- 

 roidin allows more calcium to pass out through the intestine. The amounts 

 of urine in myxedemics as a rule are very small. Often slight albuminuria 

 is found, that may probably be attributed to nutritive disturbances in the 

 kidneys. 



The assimilation limits for grape-sugar, in myxedemics, is raised (Hirschl, 

 Knopf elmacher). Hirschl found no glycosuria even after the administration 

 of 500 gm. of dextrose. Also in thyroprivic dogs the administration of sugar 

 (up to 200 gm.) does not lead to glycosuria, although in dogs the assimilation 

 limits lie relatively low. In thyroprivic dogs the glycosuric action of 

 adrenalin is reduced (Eppinger, Falta, and Rudinger, Pick and Pineles). 1 

 Myxedemics show the same relation. 



In a case of Herz's the administration of dextrose with the simultaneous 

 injection of adrenalin did not lead to glycosuria. I found the same thing in 

 the case described above (Observation XII) (100 gm. dextrose together 

 with the simultaneous administration of 2 mg. adrenalin subcutaneously). 

 After a long-continued thyroidin medication the relations become normal 

 again. In the case of Herz, after successful thyroidin treatment, traces of 

 sugar appeared in the urine after only 100 gm. of dextrose. Adrenalin now 

 again produced glycosuria. 



The inclination to glycosuria can also remain after the withdrawal of 

 thyroidin treatment. As example I quote the following case: 



Observation XIII. Rosa L. Entered the clinic June, 1895, then fifty-two years old. 

 From the history taken at the time, three confinements, first menstruation at the age of 

 fifteen years. After the confinement the menses were irregular and sparse, and ceased 

 three years ago. Then abdominal pains, jaundice, followed by a marked swelling of the 

 neck that gradually retrogressed again. Since that time there has gradually developed, 

 especially since the winter of this year, the following disease-condition; great languor, 

 rapid fatigability, rheumatoid pain, swelling of the upper and lower extremities, the 

 face, the eyelids, hoarseness of the voice, constipation and distention of the abdomen, 

 bloated condition of the face, swelling of the lips, tongue, and eyelids. The swelling of 

 the tongue and lips is so intense that it hinders eating. There are subjective sensations 

 of cold, especially on the back. Often severe headaches, sensation of vacancy in the head, 

 and feeling of anxiety. 



From the status: Skin of the extremities and on the abdomen thick, cool, and cyanotic. 



1 The alimentary glycosuria that is observed in thyroparathyroprivic dogs (Falckenberg, 

 R. IlirscK) is to be ascribed to the absence of the function of the parathyroids. (Confer also 

 Falta and Rudinger.) 



