MYXEDEMA 115 



In this case I prescribed small doses of thyroidin, and at the same time hypophysis 

 tablets, as I suspected a degeneration of the glandular portion of the hypophysis also. 

 I need only mention the fact that this medication was borne for several months without 

 calling forth the previous cardiac distresses, and that thereby the recurrence of the myxe- 

 dema symptoms was prevented. The puffiness on the neck and face had disappeared, 

 the scaling of the skin which has existed for eighteen years has disappeared, the skin has 

 become smooth and elastic, the itching has ameliorated; only the brittleness of the nails 

 has remained unaltered (communication by letter). 



The explanation for the simultaneous existence of myxedema and an 

 inclination to glycosuria that I sought in this case would serve also for any 

 case that under thyroid therapy proceeded to spontaneous glycosuria 

 (Macfie Campbell, Bramwell, Ewald, Osier, et al.}, or that without thyroid 

 therapy showed a tendency to glycosuria (Gamier and Lebret). Also com- 

 binations of myxedema and diabetes are observed, but indeed appear to be 

 very rare. The case of A pert was that of sporadic cretinism with distinct 

 myxedematous manifestations. In this case growth ceased only at the age 

 of thirty-six years. Later, diabetes appeared. I believe that it is intelligible 

 that absence or insufficiency of the function of the thyroid leads to hyperfunc- 

 tion of the pancreatic insular apparatus only when this is capable of function- 

 ating. If the pancreas itself is diseased, diabetes may occur, even when the 

 thyroid fails. This is shown by the experiments of Eppinger, Rudinger, and 

 myself on the pancreatic diabetes of thyroidless dogs. If, however, myxe- 

 dema is superadded to an already present glycosuria, the glycosuria tends 

 to disappear. Thus v. Noorden reports fourteen cases of endogenous obe- 

 sity, of whom seven formerly excreted slight quantities of sugar. With 

 the development of the forme fruste of myxedema the sugar disappeared, 

 and even a high tolerance for carbohydrates commenced. Only in one case 

 did the glycosuria persist, in mild form, during the myxedema. 



The diminution in the general metabolic processes in myxedema expresses 

 itself also in hypothermia; this belongs to the commonest symptoms of the 

 fully developed forms. The rectal temperature varies between 36 and 37 

 Celsius, and may even be below 36. It stands in relationship with the 

 sensations of cold complained of by the patients. Myxedemics feel com- 

 fortable only when the external temperature is high; their condition aggra- 

 vates in the cold season of the year; it has even been stated that in summer 

 time we may need to administer smaller doses of thyroid-gland substance 

 in order to compensate for the deficiency, and must increase the dose in 

 winter. Strong stimuli, as for example, infectious diseases, may, however, 

 also bring about hyperthermia, as numerous examples in the literature bear 

 witness. 



In severe cases of myxedema there regularly develop disturbances in 

 the sphere of the genitalia. Women develop irregularities of menstruation; 

 either the menses cease or there occur profuse floodings. In the long-stand- 

 ing cases premature climacteric occurs, and often a high degree of atrophy 



