404 



NELSON W. JANNEY 



gradually disappears and later in life, perhaps not until middle age as 

 a result of rftrophic changes, the more or less complete clinical picture of 

 hypothyroidism in the adult may develop. The frequency with which 



Fig. 9. Severe myxedema. (Courtesy of Dr. George Dock.) 



myxedemea cases on questioning report thyroid swelling in youth, often 

 long forgotten, seems more than coincidence. 



The signs of thyroid atrophy are much more often encountered than 

 is goiter, in cases developing a general symptomatology as a result of loss 



Fig. 10. The trance-like facial expression of myxedema. (Courtesy of Dr. 

 George Dock. ) 



of thyroid function. In lean individuals an undue prominence of the 

 larynx with a depression just beneath the cricoid cartilage marking the 

 location of the absent thyroid and its isthmus may be noted as a result 



