HYPOTHYEOIDISM 403 



of the gland, see Pathology of Goiter.) This may be the only demonstrable 

 manifestation of deficient thyroid function. The exposed and prominent 

 position of the thyroid led to an early recognition of this thyroid swelling 

 which received the appellation of "simple" or "benign goiter" when no 

 serious local or general lesions followed its appearance. Due to its fre- 

 quency in youth, "the goiter of adolescence" is sometimes so designated. 

 It is difficult to exactly differentiate between a swelling of the thyroid of 

 adenomatous nature due to defective thyroid hormone production and a 

 physiological hypertrophy caused by increased need for thyroxin. In the 

 latter category, most ''goiters of pregnancy" may fall, though it may be 

 questioned whether such maternal glands are still not functionally deficient 



Fig. 8. Mild myxedema. (Courtesy of Dr. George Dock.) 



if they are unable without increase in size, to provide for all the needs 

 of the adult organism including as well those of the growing embryo. 



Goiter is much more commonly met with in the endemic cretinic degen- 

 eration than in sporadically occurring hypothyroidism. Although it is 

 extremely common in young people, it is much less frequent in well de- 

 veloped cretinism. Occasionally, however, the thyroid may be grossly 

 goitrously degenerated. In Osier's (a) series of 60 cases seven had goiters, 

 Cysts are not uncommon in such adenomata. Karely pressure symptoms 

 may ensue. For clinical symptoms thus caused, see under endemic cretinic 

 degeneration. 



In estimating the importance of a simple thyroid swelling unaccom- 

 panied by other symptoms, it is well to remember the possibilities. In the 

 vast majority of cases, such goiters either disappear spontaneously or 

 with the aid of medical treatment. They may undergo colloid changes 

 and cease to be of pathologic significance. The bearers of others may, 

 however, develop thyrotoxicosis or Graves' disease, which later on may go 

 over into myxedema. A fourth outcome is possible. The simple adenoma 



