THE SYMPATHETIC SYSTEM 



77 



vessels of the neck pulsate and are plainly visible, this in 

 contrast to the very small pulse (Graves). These pulsa- 

 tions are limited to the carotids. 



Exophthalmic goitre is a vascular goitre. On palpation 

 it is elastic and semi soft; occasionally it gives a sensation 



FIG. 3. Exophthalmic goitre (Service of Dr. Florand). 



of a thrill or of expansion synchronus with the cardiac 

 systole. On auscultation a hum is often heard, most pro- 

 nounced in systole. 



Some patients tolerate this hypertrophy perfectly. 

 Others have a painful contraction of the larynx. The 

 recurrent laryngeal nerve can be compressed; in which 

 case the voice becomes hoarse. 



