420 KELSON W. JANKEY 



berant eyes or tremor (thyrotoxicosis symptoms), stunted stature, hair- 

 lessness, defective nails, etc., as family characteristics. In doubtful cases 

 in children^ the parents should be examined on account of the strong 

 familial tendency. In one instance in the writer's experience, the diag- 

 nosis became evident in the cases of three children exhibiting retardation 

 of growth through the discovery of marked dysthyroidism in the father. 



In considering the diagnosis of hypothyroidism, it is well always to 

 bear in mind that every or any tissue or organ may suffer from a decreased 

 or absent supply of the thyroid hormone. It becomes then particularly 

 important, knowing the possibilities, to note the presence of various slight 

 symptoms and signs occurring coincidentally in diverse situations. Thus 

 in children hypothyroidism is characterized by retardation of growth 

 accompanied by mental and cutaneous abnormalities with obesity. In 

 both children and adults, the psyche, face, teeth, skin and appendages 

 seldom entirely escape. The facial appearance, gait, shape of hands and 

 feet should be observed. The importance of the retardation of pulse, 

 respirations and lowered body temperature is generally underestimated. 

 The writer has been surprised at the regularity of occurrence of these 

 symptoms even in children, making proper allowance for the age. 



Laboratory tests have of late become of increasing importance in the 

 detection of hypothyroidism. As these will be treated authoritatively in 

 another section of the present work, no detailed description will be em- 

 bodied in the present article. Of prime importance is the estimation of 

 the basal metabolism. See articles of DuBois, Means and Aub, Plummer, 

 Janney and Henderson. The basal metabolic rate is decreased in pro- 

 longed inanition, diabetes with inanition, and in subfunctional endocrin 

 conditions. Inanition and diabetes can readily be excluded. Among the 

 ductless glandular diseases of subfunctional type, depressing the metabolic 

 rate, hypothyroidism is more frequently met with than any other, also 

 lowers the metabolism to a greater extent. Unfortunately, this test is not 

 now applicable to young children. It is hoped that this lack may be 

 speedily supplied. The blood glucose tolerance test of Hamman and 

 Ilirschman as standardized by Janney and Isaacson (a) may be regarded 

 as corroborative evidence of the presence of an endocrin disturbance. A 

 blood glucose curve, especially if generally lowered, and with a failure of 

 the blood siiiiar to return to the normal within two hours' time, are the 

 most important abnormalities met within hypothyroidism. 



Variations in the leueocytic formula, particularly lymphocytosis and 

 mononucleosis, though not pathognomonic of hypothyroidism, are found 

 in nearly all cases. Differential blood examinations should be made rou- 

 tinely. The importance of rontgenological studies has been underesti- 

 mated. Radiograms of the skull and extremities should be made in all 

 doubtful cases, and the developmental stage of the osseous system carefully 

 compared with the normal. (Sie>gert, Hermann (a) and Hess.) 





