286 DAVID MAKIKE 



Derated decree because of the wide range of anatomical changes dependent 

 upon the great variations in physiological activity. Hyaline transforma- 

 tion, both of the vessel walls and the stroma, accompanies normal senile 

 atrophy. It is also seen in the stroma of long standing colloid goiters 

 and of adenomata. The yellowish appearance on cut section of the in- 

 terior of many old adenomas that have partially outgrown their blood 

 supply is due to a hyaline change in the stroma. Microscopically in such 

 areas the alveoli may be absent or appear as widely scattered rings of 

 epithelial cells embedded in a hyaline matrix with few blood vessels and 

 no recognizable basement membranes. Calcareous deposits are of frequent 

 occurrence in human goiter. Indeed, they are almost always present in 

 long standing simple goiters, and occur particularly in the capsule, in 

 the stroma, the vessel walls, the scars of old hemorrhages, in cyst walls 

 or in the hyaline and scar-like centers of old adenomas. The deposits 

 may be very extensive and particularly in scar tissue frequently take 

 on the structure of bone. The frequency with which one encounters bone 

 formation in the thyroid reminds one of the frequency with which bone 

 formation is seen in lung tissue. Amyloid infiltration is usually 

 observed in connection with similar deposits in other organs, but may 

 occur independently, especially in benign tumors. Parenchymatous de- 

 generation or cloudy swelling is also seen to an exaggerated degree in 

 the thyroid. Some writers have described it under the title of Thy- 

 roiditis Simplex. This change is best interpreted as the anatomical 

 evidence of increased physiological activity, and is more striking than in 

 other tissues because the thyroid is more labile. It is seen in 

 the same associations as. parenchymatous changes of other organs, that 

 is, in acute infections and intoxications and is the precursor of true hyper- 

 trophy and hyperplasia if the cells are able to cope with the intoxication 

 or of thyroid atrophy if it is overwhelmed by the intoxication. Fatty 

 chanoes in the cell or the presence of large quantities of glycogen are par- 

 ticularly seen in adenomas and in non-aclenomatous thyroid where the blood 

 supply has been interfered with either by pressure, hemorrhage or edema. 

 Eberth (b), Kamberg, Stoffel. 



Inflammations 



(Thyroiditis, Strumitis) 



The infectious theory of goiter gave rise to the view that all true 

 goiters were chronic inflammatory reactions. There is no conclusive evi- 

 dence that iioiter is due to an infection. The general increase in fibrous 

 tissue and the occurrence of small foci of lymphocytes are parts of the 

 general thyroid reaction during active hyperplasia. There is normally 

 lymphoid tissue in the thyroid and in certain forms of thyroid hyper- 



