114 THE DISEASES OF THE THYROID GLAND 



There are present on the upper and lower extremities, and in part on the trunk, signs 

 of ichthyosis. The face, and especially the eyelids, are swollen out, so that the skin in the 

 vicinity of the eyes is markedly wrinkled. The facial expression is exquisitely sleepy, 

 the forehead transversely wrinkled so that an astonished expression is produced; the hairs 

 are dry and very much thinned out (of late years especially have fallen out). Face 

 somewhat markedly pigmented, lips protruded in a somewhat snout-like manner, the 

 teeth for the most part are missing or are loose. In both supraclavicular fossae slight 

 cushion formation. On the left the lateral lobe of the thyroid somewhat palpable. 

 Great drowsiness, and slowness of all movements. Speech very slow. Weakness of 

 memory. Gait awkward, dragging. Great fatigability. The patient was given at times 

 thyroidin tablets, which however produced cardiac palpitations and turned the constipa- 

 tion into diarrhea. However, under this treatment the swellings disappeared very rapidly. 

 In 1897 she tried thyroidin tablets, without deleterious effects. She took them ordinarily 



FIG. ii. Case of myx edema with tendency to glycosuria. 



for about fourteen days, during which time she lost weight rapidly, then she would dis- 

 continue them for about four weeks, until the pockets on the eyelids and the thickenings 

 on the abdomen appeared again. In 1895 the patient was almost bald; later the hair 

 grew again and at present she has a growth of hair about usual for a woman of her age. 

 She perspires hardly at all. For two months she has again discontinued the thyroidin 

 medication, and all the above-mentioned manifestations have recurred to an exaggerated 

 degree. After 100 gm. of grape-sugar the patient shows a distinct although not very 

 strong glycosuria; sharply delimited cyanosis of the cheeks. 



There is indeed no doubt that since the year 1895 the patient has suffered from a 

 typical myxedema. Perhaps at that time a thyroiditis appeared together with the 

 jaundice, which gradually led to insufficiency of the thyroid gland. The combination with 

 ichthyosis had been often described by French authors. From the beginning, the case 

 showed no high tolerance for thyroidin, although there was already present a myodegen- 

 eratio cordis. I can readily appreciate that in such cases palpitations can occur even 

 when the doses are not too high. 



The observation that the alimentary glycosuria resulted positive, in spite of the two 

 months' cessation of thyroidin medication, points to the fact that here, in addition to the 

 thyroid gland, the pancreatic insular apparatus is also degenerated. 



