HYPOTHYROIDISM 



407 



Fig. 13. Unusual photograph 

 contrasting the generalized 

 obesity of hypothyroidism (right) 

 with the girdle-like obesity of 

 pituitary disease (left). (Cour- 

 tesy of Drs. Wm. Engelbach and 

 J. L. Tierney. ) 



signs of the hypothyroid state. It may 

 occur at all ages although it is often ex- 

 treme about the time of puberty. In dis- 

 tinction to certain other endocrin dystro- 

 phies, the fat distribution is usually sym- 

 metrical. Sometimes the weight attained 

 is excessive. A case in the writer's series 

 attained the weight of 212 pounds at the 

 twelfth year. Even when growth is prac- 

 tically unaffected, the obesity may be high- 

 grade. Thyrogenic Obesity has been ele- 

 vated to almost the position of a separate 

 disease by von Noorden (c), and much em- 

 phasized by many writers including Her- 

 toghe and Ewald. The symptoms are those 

 of obesity, weakness, anemia, apathy, etc. 

 von Noorden especially dwells upon the 

 excellent results of thyroid treatment and 

 intolerance to ordinary reduction methods 

 which greatly weaken such individuals. 

 Such obesity is really only an expression 

 of hypothyroidism of the masked or fruste 



type of Hertoghe and deserves recogni- 

 tion merely as a prominent symptom of 

 this condition. It is well to remember 

 the possibility of subthyroid function 

 as a cause of obesity. 



All cutaneous appendages are affected 

 in the subthyroid state. The hair of 

 the head grows dry, brittle and sparse. 

 It may become prematurely grey. In 

 thyroaplasia, the scalp may be covered 

 merely with lanugo. There is never 

 complete baldness. In young cases, 

 together with the delay in appearance 

 of the secondary sexual characteristics, 

 the crines pubis and axillary hair may 

 develop late, be short, frail and small 

 in amount or, in cretins, entirely fail 

 to appear. Hair on the shins, thighs 

 and forearm, etc. may be frequently 

 absent or fall out in adult cases. 

 Alopecia may be marked, particu- 

 larly over the temples, frontal-band alo- 



Fig. 14. Hypothyroid 

 (Courtesy of Drs. Wm. 

 and J. L. Tierney.) 



baldness. 

 Engelbach 



