MYXEDEMA 



IIQ 



the hair begins to fall out, especially the hairs over the occiput, and when 

 apathy and depression are added. Sometimes many persons in the same 

 family are found with the signs of chronic mitigated thyroid insufficiency. 

 Hertoghe mentions that pronounced signs of myxedema in children first 

 drew his attention to the signs mentioned in the mother, and that thyroid 

 treatment of the mother brought about good results. Gluzinski remarks 

 that such abortive forms of myxedema in women occur not rarely in the 

 years just before the climacteric and retrogress when the climacteric has 

 been completed. The last statement has also been mentioned by Hertoghe. 

 Kocher and Fr. Kraus agree with Hertoghe concerning the frequency of such 

 forms. Kocher mentions that manifestations of chronic rheumatism that 

 are associated with pains, stiffness, and heaviness of the extremities not 

 infrequently depend upon a larval hypothyrosis. The diagnosis may also be 

 made more difficult by the fact that distentions of the joints develop. Parhan 

 and Papiniam have described a case of chronic rheumatism which they re- 

 garded as dysthyrogenic. Rothschild and Levi have tried thyroid therapy 

 on a large group of cases of chronic articular rheumatism. There were 

 twenty moderately severe and light cases among thirty-nine cases varying 

 from twelve to fifteen years of age. Of these, eighteen were cured or es- 

 sentially improved, while of the severe cases, two were cured and thirteen 

 improved. One should be very careful about regarding these forms of articu- 

 lar rheumatism as thyrogenic, as it is not unlikely that good results may be 

 brought about solely by the stimulation of the metabolism through the 

 thyroid medication. 



Hertoghe certainly goes too far when he brings myomata, retroflexion 

 of the uterus, emphysema, congestion of the liver, and gall-stone formation 

 directly into relation with the thyroid gland insufficiency (Kocher, Fr. 

 Kraus). That on the other hand we were justified in ascribing, in many 

 cases, the above-cited manifold disturbances to a chronic light thyroid 

 insufficiency speaks the fact, quite apart from therapeutic results, that Kocher 

 not rarely saw such "thyroprivic equivalents" occur after strumectomy. 



The diagnosis of such benign forms of thyroid-gland insufficiency can, 

 as can readily be understood, present great difficulties, especially when only 

 a few of the manifold symptoms are present, for instance, increased 

 heaviness of the nasal breathing, hoarseness of the voice, or a slight degree 

 of deafness. Especial attention is to be directed in these cases to the 

 presence of pseudolipomata in the supraclavicular fossae or to transverse 

 folds in the forehead (v. Wagner). Often the diagnosis can only be made 

 tentatively ex juvantibus. 



An especial form of mitigated thyroid insufficiency is thyrogenic obesity. 

 In contradistinction to so-called dietary obesity there are cases in which 

 obesity develops in spite of slight supply of calories, and remains present 

 when the supply of calories is so restricted that normal individuals of the 



