Clinical Syndromes Due to Thyroid Diseases 



Dysthyroidism 



C. P. HOWARD 



IOWA CITY 



This term has only recently made its appearance in the medical litera- 

 ture, and has been employed rather loosely to indicate quite distinct 

 groups of cases. It has been used either as a synonym for hyperthyroidism 

 or to indicate a particular group of cases with symptoms supposedly due 

 to both a diminished and an increased activity of the thyroid gland. 



Swan (a) was apparently the first to use the term in 1916 as a syn- 

 onym of exophthalmic goiter but offers no explanation for so doing. While 

 this writer was one of the few, if not the only one, to employ the word in 

 the title of his paper there have been several writers who in the course of 

 their articles have expressed the opinion that the symptom complex of 

 Graves' disease may not after all be due to hyperthyroidism or increased 

 normal secretion but rather to a perverted secretion, that is to say, to dys- 

 thyroidism. 



The most important justification for the hyperthyroid theory of 

 Graves 7 disease is that the nitrogen runs high in both Graves' disease and 

 the intoxication produced by large doses of thyroid extract, while hypo- 

 thyroidism, whether experimental or clinical, is characterized by a reduced 

 nitrogen metabolism. 



Following the example of Gushing, who speaks of dyspituitarism 

 rather than hyperpituitarism to describe a symptom complex due to dis- 

 turbed hypophyseal function, we might do well to drop the term hyper- 

 thyroidism once for all and speak only of dysthyroidism. 



There is a certain analogy between the disturbances of both the thyroid 

 and pituitary glands; thus in both a diminished function can be readily 

 recognized and what is still more important can be reproduced in man 

 and in the experimental animal by the surgical removal of one or other 

 gland. Thus removal of the thyroid gland in man results in hypothyroid- 

 ism, with the resulting well known syndrome of myxedema. A similar 

 picture can be produced in the sheep and dog. So, too, a destructive lesion 

 of the hypophysis leads clinically to adiposity with skeletal and sexual in- 

 fantilism when it appears in childhood (Frohlich syndrome) and to 



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