94 JOHN T. HALSEY 



therapy produces such results is of peculiar interest, and is of great sig- 

 nificance fcr the theory of thyroid therapy in particular and of organo- 

 therapy in general, for it furnishes the proof that ingested thyroid sub- 

 stance can exert a curative influence on a diseased thyroid. 



While this beneficial action on certain types of goiter has been clearly 

 established, it remains doubtful whether thyroid medication is more 

 effective than, or even as effective as, the administration of iodid. 

 Clinical opinion on this question is divided. A. Kocher and many 

 others consider it no more efficient than iodid, and others, prob- 

 ably the majority, believe it inferior, but v. Jauregg quotes sev- 

 eral observers who have reported successful results from thyroid 

 feeding in cases in which iodids had failed. A great objection to the 

 thyroid therapy of goiter is that by no means rarely its employment has 

 resulted in the development of a condition of hyperthyroidism. It 

 would seem that at least occasionally a case of apparently simple goiter, 

 exhibiting few or no signs of hyperthyroidism, is in reality a case of latent 

 ( i raves' disease. In such a case the administration of thyroid is almost 

 certain to prove harmful, perhaps disastrously so. 7 As a rule when thy- 

 roid substance is administered in these cases the effects are manifest in a 

 few days and reach their maximum within two to four weeks. Usually 

 tin 1 results are not permanent, a relapse occurring within a few months, 

 if the medication be discontinued. If in three weeks no results are ob- 

 tained the case is probably not amenable to thyroid treatment. Results 

 are better in the goiters of children than in those of adults. 



Dosage. If used at all in the treatment of goiter, thyroid should be 

 used cautiously. There is no justification for ever giving large doses, 

 and it is best to start with a daily dose of not more than 1 to 1% grains, 

 which should not be increased until observation during at least a week has. 

 shown that there are no deleterious effects, and then only to a daily dosage 

 not exceeding 5 grains. Satisfactory results have been obtained from the 

 administration of various thyroid preparations such as iodothyrin, thyreo- 

 irlobulin, and thyroxin. While it has been thought by some observers that 

 one or another of these preparations proved more effective than dried 

 thyroid, the direct converse lias been claimed by others. Probably the 

 eilWts of these preparations differ from each other only quantitatively, 

 so that with proportionate dosage similar effects will be obtained with 

 any good thyroid preparation. 



Exophthalmic Goiter (Graves' Disease) 



I ho weio-ht of clinical opinion appears to be overwhelmingly against 

 the u>(- ,,f thyroid therapy in exophthalmic goiter and in other conditions 



7 The same objection may be made, but perhaps with less force, against the use of 

 iodids in the treatment of goiter. 



