HYPOTHYEOIDISM 413 



able to emit but a few unintelligible sounds. All gradations occur from 

 the expression of the simplest wishes to a good command of conversation. 

 The voice is often raucous or nasal due to myxedematous swellings in 

 the larynx and nasal passages. In adults vocal changes occur, as well 

 as the tone scale becoming limited, a monotonous syllabation thus ensuing. 

 It is probable that degenerative fibrillary changes in the vocal cords play 

 here a part. Aside, however, from such local causes, we are confronted by 

 the question of the mutual influence of possible deficiency in higher cere- 

 bration (word deafness), as well as defects in motor speech areas. 



The Respiratory System. On account of the defective development 

 of the bones of the face, the nares and nasal passages are often small in 

 young subjects. Myxedematous thickenings of the nasal mucosa may lead 

 to snoring and snuffing. This is regarded by Curtis as the earliest sign 

 of myxedematous infiltration. Chronic rhinitis is frequent. There may 

 be a marked tendency to pick up respiratory infections. Occasionally this 

 alone may bring the patient to a general medical examination and the hypo- 

 thyroid condition is discovered. Adenoids may obstruct the posterior 

 nares, 



Slow respirations are the rule. They may fall to as low as eight a 

 minute. Dyspnea and a sense of oppression are often complained of. 

 These symptoms seemed caused by the possible combination of nasal ob- 

 struction with weakened respiratory muscles and involvement of the vagi. 

 Hertoghe calls attention to the similarity of the dyspneic attacks to asthma. 

 True asthma is not infrequently met with in young subjects with defective 

 thyroids. A certain percentage of asthmatics not responding to protein 

 tests, are due to endocrinopathies (G. Piness, G. Self ridge) including 

 hypothyroidism. 



Cardiovascular System. In common with all organs requiring active 

 metabolic processes for performance of their functions, the heart may 

 suffer severely in hypothyroid subjects. Valvular lesions are common. 

 Myocardial degeneration may occur also in young persons. Weak cardiac 

 impulse and the first sound at the apex may call to mind the senile type 

 of myocardial insufficiency. This condition and the trophic degeneration 

 of the cardiac enervation are productive of a sluggish circulation, slow 

 small pulse, and the precordial distress occasionally complained of. For 

 remarks on "goiter heart" see under Cretinic Degeneration. 



The blood vessels of the older hypothyroid subjects frequently exhibit 

 arteriosclerosis rarely with atheromatous plaque formation. High blood 

 pressure is unusual, however, in spite of degenerative changes exhibited 

 at times by the renal epithelium. The symptoms of precordial pain, pal- 

 pitation and tachycardia experienced by certain hypothyroid patients on 

 beginning treatment may, aside from overdosage, be due to the rapid with- 

 drawal of infiltrating substances (Hertoghe) or very possibly to the un- 

 usual stimulation of the degenerated cardiac muscle. 



