TREATMENT OF ATHYROSIS AND HYPOTHYROSIS 143 



Mabille believes that the simultaneous administration of small doses of 

 arsenic prevents the occurrence of symptoms of hyperthyroidism. Ewald 

 agrees with him. Magnus-Levy missed this action of arsenic. Hertoghe 

 warns against the administration of alcohol or morphine during the thyroid 

 medication. He recommends administration of sodium bicarbonate, or, 

 when diarrhea occurs, of bismuth. 



In general we may well assume that typical cases of myxedema show a 

 high tolerance for thyroidin. When manifestations of thyroidism occur, the 

 cause of these may lie in a simultaneous degeneration of the heart muscle, 

 that reacts more quickly to thyroid medication, or we are probably not deal- 

 ing with typical myxedema, but with a combination of myxedema symptoms 

 with symptoms of deficiency on the part of the other ductless glands (see 

 multiple sclerosis of the ductless glands). 



The action of thyroid medication in sporadic cretinism deviates in many 

 points from that just described. On the one hand, there here occurs a num- 

 ber of other disturbances which relate to the existing disturbances in develop- 

 ment (growth in size, dentition, sexual sphere, etc.); on the other hand, it 

 is intelligible that with the long existence of the inhibition of development 

 degenerative conditions have become established that are no longer reparable. 

 Very significant results are hence to be expected only in light forms or when 

 the treatment has been started early. Very significant seems to be the 

 influence on growth. Already in 1896, Buschan collected from the literature 

 thirty-two cases which showed rapid growth under thyroid medication. 

 Latterly, statements as to this subject have considerably increased. 



X-ray examination shows that with the increased growth in height there 

 occurs rapid appearance and growth of the bone nuclei, or rapid ossification 

 of the epiphysial junctures. 



Hertoghe states that in myxedematous children under certain circum- 

 stances, administration of thyroid may lead to such a rapidly increased 

 growth in height that scoliosis or kyphoscoliosis develop. In the fully 

 developed form of sporadic cretinism in which the epiphysial junctures are 

 often fully open in the third and fourth decade, there may still occur under 

 thyroid medication, appreciable growth in height and finally closure of the 

 epiphysial junctures and the fontanelles. 



As is the case with ossification, the previously retarded dentition also 

 shows a sudden acceleration. I cite from the reports of Kassowitz the 

 following example: A twenty- two-month-old child had not a single tooth; 

 after a six months' treatment sixteen teeth had erupted. A similar accelerat- 

 ing influence is exercised on the formation of the permanent teeth. A ten- 

 year-old girl had only remnants of the milk-teeth; after one year's treatment 

 she possessed six, after two years' treatment eighteen permanent teeth. 

 Very pretty examples of the stimulation of growth through thyroid medica- 

 tion are found also in Oppenheim's text-book of neurology and in Siegert. 



