76 ENDOCRINE GLANDS 



of heat, flushes, palpitations, insomnia. On casual exam- 

 ination a swelling of the thyroid is noticed and an 

 acceleration of the pulse rate. Very often this condition 

 is interpreted as hysteria or nervousness. 



Slowly the characteristic signs of the disease become 

 prominent. 



1. TACHYCARDIA. This is a very important sign, as it 

 appears early and is very constant. The patient com- 

 plains after the slightest effort, or the least excitement, of 

 palpitations, at first intermittent and in the end constant. 

 During the day time they sometimes have a sensation 

 of discomfort which is very painful; at night they com- 

 plain of palpitations and sleep poorly. 



The pulse is rapid ; 90 to 120 per minute. It is small, but 

 generally regular, although in some cases it can be very 

 variable. Following a slight effort or excitement, it will 

 go up to 100, 150, or 180. This acceleration of the pulse 

 occasionally occurs spontaneously and coincides with 

 attacks of palpitation. Quite often there is a slight rise in 

 blood pressure. 



The examination of the heart reveals an abnormal 

 cardiac condition. The wall is pushed forcibly at the apex 

 and can be easily palpated. Auscultation reveals a tachy- 

 cardia, either simple or associated with extra cardiac 

 murmurs. If organic murmurs are present, these are prob- 

 ably due to some previous rheumatic endocarditis (Barie). 



2. THE GOITRE. Very soon the volume of the thy- 

 roid increases, obliges the patient to wear larger collars or 

 a more opened waist. Sometimes under the influence of 

 fatigue or menstruation it grows very rapidly and in the 

 interval goes down slightly. 



At an advanced period the hypertrophy of the gland 

 causes a deformity of the neck, generally asymetrical. 

 The right lobe being nearly always the largest. The 



