CHAPTER I. 

 I. THYROID INSUFFICIENCY SYNDROMES. 



An insufficiency in thyroid secretion results in a series 

 of dystrophic conditions known under the name of myx- 

 edema. 



1. ADULT MYXEDEMA. 



This condition was described by Gull (of London) in 

 1873 under the name of cretinism. It was studied by Ord 

 who suggested the name of myxedema, then investigated 

 in France by Morvan and by Charcot. 



It occurs between the ages of 30 and 60, more frequently 

 in women than men, usually as a result, sometimes a long 

 time afterwards, of some infectious disease; articular 

 rheumatism, typhoid, scarlet fever, etc., which has af- 

 fected the thyroid and altered its secretion. 



The condition begins very insidiously and is at first 

 marked by fatigue, weakness, persistent anemia and a 

 gradual intellectual stupor. It is finally characterized by 

 three important symptoms: infiltration of the tissues, 

 atrophy of the thyroid and mental degeneration. 



1. INFILTRATION OF THE TISSUES. The appearance 

 of the patient is typical. " Considered as a whole, the face 

 is large and round, resembling a full moon," according to 

 the descriptive report of Gull. :4 The lids are infiltrated 

 and cover the eyes so that they appear smaller; the nose 

 is enlarged, the lips thick and protruding, the forehead 

 and the ears are wrinkled, the cheeks are puffed and 

 flabby. This tumefaction of the face is associated with 

 changes in the coloring; the skin has a yellow waxy pallor 

 with a marked redness of the cheeks and a slight cyanosis 



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