328 C. P. HOWAED 



believes that the widespread opinion that the blood pressure is low is due 

 to the quick pulse, which in many cases seems to the touch that of low 

 tension ; this quick pulse, he points out, depends upon a large pulse-pres- 

 sure. Dock noted in almost 60 per cent of his patients a systolic pressure 

 above 130 mm. of mercury. 



Kraus believes that the blood pressure varies greatly in exophthalmic 

 goiter but is usually increased slightly above normal and responds more 

 rapidly to stimulation than does the pressure of a normal individual. Orth 

 noted a high blood pressure in seventy per cent of his goiter patients, 

 which after thyroidectomy fell below normal, but gradually righted itself 

 in a few weeks. According to Plummer (c), in 117 cases which were more 

 than forty years of age, 47 per cent had a systolic blood pressure above 

 150, and 34 per cent above 160 mm. of Hg. Even if one looks at his 

 tables of percentage by decades, one finds a pressure above 160 mm. in 

 12 per cent in the second, 17 per cent in the third and 22 per cent in the 

 fourth decade. This forms only a slight contrast to the systolic pressure 

 of non-hyperplastic goiter in which 18 per cent of the subjects had a 

 systolic pressure above 160. The percentages are distinctly lower in the 

 first four decades, however, and form therefore a more definite contrast. 



Plummer believes that the high systolic blood pressure, though transi- 

 tory, is due to the same factors that later lead to high diastolic blood 

 pressure and permanent cardiovascular changes. After studying Plum- 

 mer's tables we can state that in 81 per cent of hyperplastic goiter 

 (Graves' disease) and in 62 per cent of simple goiter in patients over 

 forty years of age the systolic blood pressure was above 150 mm. of Hg. 

 A fall in blood pressure may be considered indicative of cardiac in- 

 sufficiency and as an unfavorable prognostic sign. "The high pulse- 

 pressure with the well known vasomotor phenomena of Graves' disease 

 leads to the almost unquestionable conclusion that there is no vascular 

 hypertension 2 in this condition. The high systolic pressure is essential 

 to the maintenance of a normal diastolic blood pressure in these cases 



having a low peripheral resistance 



That the long continued intoxication associated with the hyperplastic 

 thyroid may lead to hypertension is probable." 



Finally Swan from a study of the blood pressure in fifty cases con- 

 cluded "that the first effect of dysthyroidism on the blood pressure is 

 to produce a lowering of the systolic pressure. This is accompanied by 

 a disturbance in the pulse pressure, usually an increase. After the case 

 has persisted for a varying period, the systolic blood pressure begins to 

 rise, and after the development of cardiac hypertrophy and renal and 

 vascular changes, the cases are converted into typical cases of chronic 

 hypertension." 



A consideration of the above evidence will permit the statement that, 



'Italics mine. C. P. H. 



