142 THE DISEASES OF THE THYROID GLAND 



ideas disappeared entirely; with the withdrawal of the medication the myxe- 

 dema and also the mental disturbance recurred. A renewal of the therapy 

 again brought about cure, that remained definite in spite of discontinuation of 

 the treatment. This patient had a goiter. Pilcz supposes that in this case 

 the thyroid gland regained its activities through the stimulating influence of 

 thyroid medication. Also the hardness-of-hearing sometimes accompanying 

 myxedema often shows a decided improvement. The English Myxedema 

 Commission found that among one hundred and nine cases of myxedema, 

 nearly the half showed disturbances of hearing; this disappeared under 

 thyroid treatment. Also speech becomes livelier, even at the beginning 

 of treatment, as Magnus-Levy states. In many of the cases stuttering 

 appears at the beginning of the medication. Gutzmann explains this in the 

 fact that the desire for speaking becomes rapidly increased, while there is a 

 certain awkwardness of speech due to inhibition of the peripheral speech 

 mechanism (swelling of the mucous membrane of the mouth, the nose, the 

 throat, and slight mobility of the velum palati). Then, too, the disturbances 

 in the sexual sphere improve, often astonishingly. The dysmenorrhea dis- 

 appears, the long-absent menstruation may recur, in men potency may 

 again return. Existing albuminurias tend to disappear. 



The results of thyroid medication' in typical cases is to be regarded as 

 almost certain. Already Heinzheimer has collected one hundred and fifty 

 cases from the literature in which a complete favorable result was brought 

 about by the treatment. Cure can occur even when myxedema has existed 

 for a long time. In a case of Dunlop the myxedema had existed for twelve 

 years. 



In the cases of formes frustes of myxedema the results are just as satis- 

 factory. Especially in the cases of thyrogenic obesity, thyroid medication, 

 as already mentioned, brings about, with diet freely chosen and with improve- 

 ment of the general conditions, a rapid reduction in weight, while marked re- 

 duction of the caloric supply only produces conditions of weakness. 



Sometimes, indeed, the results of thyroid medication in myxedema are not 

 so revolutionary. In the first place it may happen that on account of the long 

 duration of the disease more deeply seated disturbances have developed, 

 for example, high-grade anemia, which then furnishes a slight resistance to 

 the administration of thyroid gland. In other cases symptoms of thyroidism 

 rapidly appear, which call for the limitation or eventually the discontinuation 

 of the agent. In such cases it may happen that the symptoms of myxedema 

 are only a little influenced while tachycardia, insomnia, excitation, etc., make 

 their appearance rapidly. Such a case was first described by Beclere. Here 

 the myxedema gradually disappeared. There occurred, however, rapid loss 

 of weight, tachycardia, insomnia, excitations, polyuria, albuminuria, partial 

 paraplegia, sensation of heat, sweats, tachypnea, transitory tremor, and a 

 slight grade of exophthalmus. 



