THE SYMPATHETIC SYSTEM 89 



V 



II. THE VARIOUS BASEDOW's DISEASE SYNDROMES. 



To the typical Basedow's disease are related a number 

 of clinical syndromes of various etiology. These syn- 

 dromes are related to the existence of a goitre. They are 

 also secondary to the ingestion of thyroid products or of 

 iodides. They may also be of ovarian origin. 



I. Pseudo EXOPHTHALMIC GOITRE. 



Certain goitres compress the cervical sympathetic on 

 one or both sides and cause an exophthalmia, associated 

 with an acceleration of the heart without any other sign 

 of Basedow's disease. 



There are simple goitres which for years evolute without 

 any disturbance; then under the influence of overwork or 

 sorrows or following the administration of iodides, some- 

 times even without any evident cause show evidence of 

 Basedow's disease. In these cases not only is exophthal- 

 mos and tachycardia noticed, but signs of thyroid intoxi- 

 cation : tremors, vaso motor disturbances, psychic changes 

 diarrhea, etc. 



These can be differentiated from the classical Basedow's 

 disease by the following characteristics : the goitre has been 

 perfectly well tolerated for a number of years, the palpa- 

 tion of the thyroid reveals at least in one of the lobes the 

 presence of cartilagenous or fibrous masses, while true 

 exophthalmic goitre is a soft goitre and is essentially 

 vascular. Surgical treatment improves or cures these cases. 



Certain cases of cardiopathy, associated with goitre, can 

 be classified very closely to Basedow's disease. Some 

 patients with a simple goitre show prominent cardiac 

 symptoms; in some the symptoms are those of cardiac 

 insufficiency, complicated with pulmonary stasis second- 

 ary to pulmonary lesions of bronchitis with emphysema. 



