MYXEDEMA I I 7 



(pathological correlation) is very rare. I shall deal with it in detail in the 

 chapter on the hypophysis. Often in such cases thyroid-gland medication 

 causes a disappearance of only a portion of the cachectic symptoms. We 

 shall deal later with the alterations in the hypophysis in infantile myxe- 

 dema. The combination of myxedema with tetany is considered in the 

 fourth chapter. 



Etiology and Course. We to-day possess a complete explanation of the 

 etiology of myxedema operations. Total extirpation of the thyroid gland 

 always leads to myxedema, which in very rare cases may be only slight 

 and may heal spontaneously, this manifestation being due to the compen- 

 satory hypertrophy of accessory thyroids (cases of Vollmann and Reverdin). 

 It is very noteworthy that in cases of accessory struma of the base of the 

 tongue, extirpation of the tongue struma led to myxedema. Seldowitsch 

 and Chamisso have each reported such a case. After operations for struma, 

 mitigated forms of myxedema operations often appear, forms that show, for 

 example, only disturbances of growth, or only fat deposits, or only apathy. 

 Among thirty-eight cases of cachexia strumipriva, Kocher saw the miti- 

 gated form only nine times; here recurrences of the goiters developed. 

 If a thorough continual treatment with thyroidin be not instituted there is 

 shortening of the thyroidectomized individual's life. Total thyroidectomies 

 are to-day still performed only on malignant degenerations of the thyroid 

 gland. Mitigated operative myxedema may also occur to-day where there 

 is intense degeneration of the part left behind. 



The pathologico-anatomical finding in the thyroid in so-called spontaneous 

 myxedema is ordinarily sclerosis with destruction, or a high-grade goitrous 

 degeneration. In many cases of spontaneous myxedema only fat and con- 

 nective tissue (Abrikosoff) is found on the site of the thyroid. Only in rare 

 cases is the etiology of the inflammatory cirrhosis clear, as for example in 

 Kohler's cases of syphilis and actinomycosis respectively of the thyroid, the 

 first yielding to the effects of potassium iodide, the latter to operation, v. 

 Wagner observed two cases of formes frustes in the eruptive stage of syphilis; 

 in the later stages of syphilis infiltrates and gummata are present. Tuber- 

 culosis of the thyroid gland is relatively not very common. Also miliary 

 tuberculosis has been observed. Primary tuberous tuberculosis seems to be 

 very rare. In certain cases of multiple sclerosis of the ductless glands there is 

 found in the thyroid, in addition to diffuse chronic processes, also, in some 

 places, tuberculous foci. In most of the cases of spontaneous myxedema 

 there were perhaps other infections than those stated. The territory has 

 not as yet been explored bacteriologically. An index is furnished by those 

 cases of myxedema that appear after cases of infectious diseases. Thus 

 Reinlinger reports a case of an individual, twenty-two years old, who after 

 a gastric fever (typhoid?) developed cachexia, myxedema of the skin, apathy, 

 dementia, and falling out of the axillary and pubic hair. Thyroid therapy 



