THE SYMPATHETIC SYSTEM 95 



V. SURGICAL TREATMENT. 



1. Partial thyroidectomy, care being taken to leave 

 untouched the parathyroids, to avoid tetany, and pre- 

 serve enough of the gland to prevent myxedema is a 

 commonly used method of treatment. 



2. Ligations of some of the blood vessels of the thyroid 

 is considered by some to be the method of choice. 



3. Sympatheticectomy, advised by Jabouley, is practi- 

 cally never used any more. 



THERAPEUTIC INDICATIONS. 



All the methods of treatment given are not exclusive 

 and can be associated with advantage. 



1. In classical exophthalmic goitre etiological treat- 

 ment should be attempted: specific medication in goitre 

 of syphilitic origin; salicylates if the patient has had acute 

 articular rheumatism. 



In the majority of cases all etiological indication is 

 missing. The patients are first put on a regime of abso- 

 lute mental and physical rest, then antithyroid medica- 

 tion is first tried. If the patient does not react to it, 

 there is no use continuing the treatment too long. The 

 electric treatment should next be tried, then radiotherapy 

 associated with symptomatic medication or organo 

 therapy, depending on the case. 



If medical treatment fails or makes the condition worse 

 then surgical treatment is indicated. This is counter- 

 indicated in the cachectic cases and those with cardiac 

 insufficiency, however. In the acute form with rapid 

 evolution which usually resists all medical treatment, 

 thyroidectomy should be resorted to. 



2. In goitres with symptoms of Basedow's disease, 

 some are improved by antithyroid medication, others by 

 thyroid organo therapy given carefully and in small doses. 



