HYPOTHYEOIDISM 425 



thyroidism is usually characteristic. A case which came under personal 

 observation had spent many months in a madhouse. Under prolonged 

 thyroid treatment a practical recovery ensued. 



The writer has been surprised by the relative frequency with which 

 subthyroid individuals have been diagnosed as cases of neurasthenia. It 

 does not seem to have been sufficiently impressed upon the minds of the 

 profession at large that many of the symptoms of neurasthenia are merely 

 those of hypothyroidism. Thus one may mention the easy mental and 

 physical fatigability, the loss of power of concentration, eye-strain for 

 insufficient cause, the irritability and depression, the itching skin, the par- 

 esthesias, the reflex gastric and intestinal disturbances, the vague malaise, 

 also muscle and joint pains. More careful clinical studies with proper 

 diagnostic aids, such as the basal metabolism, will discover more endocrin 

 cases among these discouraging individuals. 



The Obesities. It seems scarcely justifiable to ever regard thyrogenic 

 obesity as a disease per se, as it is actually but a prominent symptom of 

 decreased thyroid function, i. e., hypothyroidism. Therefore, it would 

 rather be preferable to regard the differentiation of the endocrin obesities 

 in the light of their causal conditions, hypopituitarism, eunuchoidism, etc., 

 to which allusion has already been made. 



Adipositas dolorosa (Dercum) deserves special mention. This condi- 

 tion of painful obesity cannot be clearly differentiated in all cases from 

 hypothyroidism, as chronic thyroid lesions, sometimes of inflammatory 

 nature, have been found in the majority of the autopsied cases. Patho- 

 logical changes in other ductless glands have, however, been observed and 

 opinions as to its etiology are conflicting. Clinically, the psychic changes, 

 general weakness, and obesity suggest hypothyroidism but painful fat 

 nodules and the freedom of the face from myxedema or invasion by the 

 lipomatous overgrowth distinguish this condition rather clearly. 



Prognosis 



The prognosis of athyroidism in the untreated state is fatal. Pew 

 survive the very early years. No authentic case seems to have reached 

 maturity. Death usually ensues from intercurrent disease due to lowered 

 resistance. In general, the prognosis of athyroidism and hypothyroidism 

 depends on efficient treatment with thyroid preparations. As such therapy 

 requires painstaking scientific control, one is scarcely justified in consider- 

 ing thyroid deficiency so readily curable as the older text-books suggest. 

 The age of the patient at the time treatment is begun greatly influences 

 prognosis. If previous to closure of the epiphysis, growth on proper treat- 

 ment may again be established and a nearly normal organism result. 



If treatment be begun at a later period the prognosis is less favorable. 



