Il8 THE DISEASES OF THE THYROID GLAXD 



produced good results. Marfan saw myxedema develop after an acute artic- 

 ular-rheumatism with angina. Sometimes, as previously mentioned, the hy- 

 perplasia of Basedow's disease goes over into atrophy. The investigations 

 of Roger and Gamier, de Queroain, Sarbach, Bayon, and others have shown, 

 however, that in severe infections diseases there regularly develop in the 

 thyroid inflammatory processes, and in chronic intoxications cirrhotic 

 processes. 



The reason that myxedema is commoner in women than in men should 

 be sought in the fact that the normal sexual processes in women determine 

 an important affection of the function of the thyroid, and that an exhaustion 

 of this is produced the more easily by damages to the parenchyma due to 

 common infections or intoxications. For this assumption speaks the fact 

 that mitigated forms of hypothyrosis tend to become worse during pregnancy 

 and that not rarely the myxedematous symptoms disappear at the sexual 

 involution. 



Finally, it should here be mentioned that sclerotic processes are found 

 in the thyroid in numerous cases of scleroderma (Singer, Hektoen, Rouoc, 

 Leredde and Thomas, and others}. Eventually, in many cases of sclero- 

 derma are found also symptoms that remind one of myxedema (Cresset, 

 Osier, and others). As scleroderma involves in sympathy the most diverse 

 organs, we readily see that we should best regard the alterations in 

 the thyroid as a partial phenomenon of the fundamental processes (see 

 Chapter I). 



Differential diagnosis is concerned first of all with nephritic edema. 

 Slight presence of albumin [in the urine] may also occur in myxedema. We 

 should especially consider the density of the swellings, the failure of hyper- 

 tonia, and the presence of psychic alterations. Also, in myxedema, the 

 swellings are often more distinct in the morning than in the evenings. 



Stabile erysipeloid edema, indurative syphilitic edema, and pachyderma 

 are distinguished from myxedema by normal psychic relations ; nor do they 

 react to administration of thyroidin. Thyroid medication may affect 

 favorably scleroderma (stimulation of metabolism, Ewald) ; the same holds 

 good of certain cases of lipomatosis dolorosa (Dercum) . In many such cases 

 alterations are found in the thyroid, in others in the hypophysis (see 

 Chapter XIV). 



The incomplete forms of myxedema are of difficult diagnosis. Hertoghe 

 first drew attention to these, designating them chronic benign hypothyroid- 

 ism. They are much commoner and more multiform in women. They often 

 begin with chronic muscular pain, which may disturb sleep. Rachialgias 

 are especially frequent, to which may be added great lassitude, especially 

 in the morning hours, menstrual disturbances, menorrhagias or amenorrhea, 

 sensation of cold, even shiverings, hoarseness of the voice, and, especially 

 often, rather obstinate constipation. The picture becomes clearer when 



