336 C. P. HOWAED 



Disturbances of Metabolism 



In 1893 Friedrich Mueller (a) demonstrated a great acceleration of 

 the metabolism in Graves' disease. Since then many investigations have 

 been undertaken and have revealed the fact that the disturbances involve 

 the total combustion as well as protein, carbohydrate, fat and mineral 

 metabolism. 



Basal Metabolism in Exophthalmic Goiter. 3 The total combustion 

 or general heat production or the "basal metabolism" of modern parlance 

 is measured by the carbon dioxid production and oxygen consumption. 

 The emaciation is related to the increased total metabolism and the re- 

 markable increase of the consumption of oxygen and the output of carbon 

 dioxid. In severe cases of Graves' disease the increase of oxygen con- 

 sumption amounts to as much as fifty to seventy per cent an increase 

 which Magnus-Levy (e) states "occurs nowhere else in the whole range of 

 pathology." Instead of three and a half to four cubic centimeters of 

 oxygen per kilogram, Magnus-Levy found that the values may rise to 

 four and a half, six or even seven cubic centimeters. "The fires of the 

 body are, as it were, fanned into an intense flame," as Barker succinctly 

 puts it. A patient having hyperthyroidism, though at rest, may use as 

 much oxygen as a normal man at hard labor. This acceleration of the 

 oxidative processes may strain the heat regulating mechanism, conse- 

 quently slight elevations of the body temperature frequently occur. 



According to Steyrer the total caloric output is definitely increased: 

 this affects both the fat and proteid intake. The caloric production in 

 Graves' disease is a strikingly variable one under similar feeding and 

 other external conditions. It seems clear to Steyrer that these variations 

 run parallel to the general nervous instability of the organism. Slight 

 differences of body weight are scarcely noticeable and depend upon the 

 amount of protein intake. Administration of thyroid extract, even in 

 largo doses, called forth no marked increase of the energy requirements. 

 There exists, therefore, a remarkable contrast between the exophthalmic 

 goiter and the myxedema patient. The increased basal metabolism is not, 

 according to Pribram and Forges, influenced by abstinence from meat or 

 other protein foods, but overfeeding with meat causes an increased rate. 

 There is, therefore, no indication for a vegetarian diet. Further, in 

 spite of an increase in the body weight, they could note no reduction of 

 this increased metabolism from X-ray treatment over the thyroid gland. 

 DuBois concludes that the measurements of the heat production gives us 

 the best index of the severity of the disease and of the effect of treatment. 

 In severe cases the warmth of the skin and the sweating can be ac- 

 counted for entirely by the necessity for the increased elimination of 



3 This topic is further discussed in another chapter. 



