98 JOHN T. HALSEY 



My own experience has been that, after excluding clearly hypothyroid 

 cases, my Best results have been obtained in cases of young and middle 

 aged women in whom obesity was associated with scanty or irregular 

 menstruation or with amenorrhea. 



Unquestionably, if carelessly used in the treatment of obesity, thyroid 

 can and does do serious damage, but the writer believes that its harmful- 

 ness (when properly used) has been exaggerated by too many authorities 

 and that its cautious, carefully controlled administration has been of dis- 

 tinct value in a considerable proportion of the cases in which he has 

 employed it in conjunction with other measures. The most brilliant 

 results will be obtained in cases of the so-called constitutional obesity or in 

 cases of obesity showing other signs of hypothyroidism. However, it is 

 my belief that in any case of obesity, not responding well to diet, purgation 

 and exercise, it is well to make a trial of thyroid feeding while continuing 

 the same regime. This should be done cautiously, starting with one grain 

 three times a day and increasing gradually until favorable or unfavorable 

 effects are noted. If three to five grains thrice daily do not exert an 

 unmistakable influence, I do not persist in the administration, as I fear 

 the harmful effects of larger doses. In a goodly proportion of my own 

 cases the results have been most gratifying and I have seen no bad results. 

 I have, however, seen cases of obesity treated with thyroid before coming 

 under my observation, in whom it would appear that harm (not very 

 serious) had been done, and it must not be forgotten that the claim has 

 been made that abuse of thyroid feeding in the treatment of obesity has 

 caused the Basedow symptom complex to develop (von Notthaft). The 

 physician or patient, however, who expects a satisfactory reduction in 

 weight from thyroid medication unassisted by other approved measures, 

 will rarely fail to bo disappointed, and whoever attempts thus to obtain 

 favorable results runs a grave risk of doing serious harm. 



Empiric and Symptomatic Thyroid Therapy 



Thyroid treatment of the various diseases and disturbances of func- 

 tion, as discussed in the preceding sections, may be considered true organo- 

 therapy (substitution! therapy), as there are good grounds for assuming 

 that they arc all (certain types of obesity excepted) more or less entirely 

 due to deficiency or disorder of the thyroid function. In addition to those 

 already discussed, there are a very considerable number of other diseases 

 and conditions in which the value of thyroid administration has been more 

 or less definitely established, hut in which hypo- or dysfunction of this 

 gland has not heen demonstrated (and in some of which not even assumed). 

 Hem the, employment of this treatment rests largely on an empiric basis, 

 i. e., on the effects which have been obtained in clinical trial, for which 



