96 JOHK T. HALSEY 



tain cases of exophthalmic goiter, the hypothesis has been made that there 

 are cases ill which the overactivity of the gland has been caused as follows : 

 Originally in these cases the thyroids are hypoactive and produce too small 

 an amount of secretion. This deficit of thyroid hormone then reacts 

 on other organs and tissues in such fashion that they are caused to call 

 on the thyroid for increased activity, with the result that the fatigued or 

 diseased thyroid responds to this stimulus by an overproduction of its 

 hormone, which then causes the symptoms of hyperthyroidism, although 

 the case is (according to this hypothesis) in reality a case of hypothy- 

 roidism. The hypothesis, while ingenious, appears not only to lack all 

 basis of demonstrated fact but also to be so fantastic as to justify its prompt 

 reject ion. 9a 



After all, until we obtain a fuller understanding of Graves' disease, 

 the question as to whether or not thyroid therapy is even occasionally 

 useful in it must be settled by close clinical observation of cases thus 

 treated. Such favorable reports, as I have been able to find, are (to me) 

 not in the least convincing, for exophthalmic goiter is a disease very erratic 

 in its course from day to day and almost from hour to hour. That in most 

 cases thyroid therapy is harmful cannot be questioned. That it is even 

 occasionally useful (except when the patient showns signs of hypothyroid- 

 ism) has not in my opinion been demonstrated. 10 



Obesity 



The striking increase in metabolism, caused by administration of 

 thyroid and the clinical observation that obesity, more or less pronounced, 

 was a common feature in myxedema and other conditions of hypothy- 

 roidism, naturally suggested that thyroid might prove useful in the treat- 

 incut of obesity. !>arron appears to have been the first to test this 

 clinically, and lie and others quickly demonstrated that in many cases 

 of obesity the administration of thyroid was followed by a prompt and 

 decided loss in weight, often amounting to as much as 2 to 10 pounds 



treatment involves much more than this the reader desiring to familiarize himself 

 with Rogers' views is referred to the section on Exophthalmic Goiter and its treat- 

 ment and to Kogers' own communications. 



11:1 'I liat the overstimulated but inefficient thyroid might, under the assumed con- 

 ditions, elaborate an incomplete, toxic secretion is conceivable. The patient might 

 thus simultaneously manifest hypothyroidism and thyrotoxicosis. Janney has elab- 

 orated this idea. 11. (J. II. 



"'Personally 1 have never felt that I was justified in giving thyroid to a case of 



exophthalmic goiter (or to one presenting any signs of hyperthyroidism) unless the 



lent had passed temporarily or permanently into a stage of. hypothyroidism or into 



age. in which there were at the same time signs of both hypo- and Interactivity 



gland (if such ever occur). Consequently I have myself never obtained bad 



s administration in this disease. In a limited number of my own cases, 



Inch, on the advice of other physicians, had taken thyroid, I have never seen bene- 



ch, ui my opinion, could with any probability be attributed to this 



.itmunt, and some of the patients were certainly harmed by it 



