OKGANOTHEKAPY AND HORMONOTHEKAPY 93 



phasized, a group of patients with thyroid instability in which stages of 

 hyperthyroidism and hypothyroidism alternate. These authors also be- 

 lieve that hypothyroidism is very often the sole or main cause of migraine, 

 chronic arthritis, mucous enteritis, urticaria and other skin affections, 

 especially acne and eczema, and of mental symptoms. 



It cannot be questioned that, when any of the above mentioned dis- 

 turbances are present in cases of hypothyroidism, thyroid administration 

 often proves strikingly beneficial and it appears equally beyond question 

 that the majority of the medical profession, as they do not realize the 

 possible thyroid causation (partial or complete) of such conditions and 

 symptoms, do not sufficiently often make use of thyroid feeding in their 

 treatment. However, the fact that thyroid administration will relieve 

 constipation, amenorrhea, migraine, arthritis, and so forth, in hypothyroid 

 individuals is no proof that, as some enthusiasts believe, this treatment 

 will be beneficial in all or even in the majority of patients suffering from 

 these complaints. It would appear therefore that the therapeutic lesson 

 to be drawn from the reported successful employment of the thyroid, 

 in such conditions as have been enumerated above, is that the physician 

 should bear in mind the possibility that they may be expressions of thyroid 

 insufficiency and that therefore a cautious trial of thyroid therapy is not 

 only justified but indicated, at least in subjects in whom careful observa- 

 tion indicates, with some degree of probability, that the thyroid may be 

 hypoactive. 



Dosage. The doses required in these cases of mild or doubtful hypo- 

 thyroidism are usually very small. For an adult the initial or tentative 

 dose should be from 1/10 to % grain three times a day, and it should be 

 increased only gradually if at all. It is especially important to give only 

 small doses if there be any doubt as to the hypothyroidism. Larger doses 

 than 1 or 2 grains three times a day will rarely if ever be required in this 

 type of case, and the effects of even the small doses must be carefully noted 

 if harmful or even disastrous results are to be avoided. 



Goiter 



Thyroid therapy exerts a so unmistakably favorable effect on goiters 

 (other than those of hyperthyroidism) that it has been extensively used 

 both for therapeutic purposes and, especially during an earlier period, 

 as a method of testing the activity of different thyroid preparations. 6 To 

 Reinhold belongs the credit of this discovery, which was promptly con- 

 firmed by others, notably by von Bruns. The demonstration that thyroid 



8 The actuality of this action has been most conclusively demonstrated not only by 

 thousands of clinical observations but also in such experimental studies as those of 

 Bruns who, by examination of segments of the goiter, removed before and after the 

 administration of thyroid, was able to demonstrate histologically that tissue changes 

 of a beneficial type had resulted. 



