432 KELSON W. JAKNEY 



decrease in the basal metabolism experimentally in animals after ovariec- 

 tomy. It should also be recollected that inanition and various endocrinop- 

 athies other than the thyroid depress the gaseous exchange and may in 

 complicated cases, such as the pluriglandular syndromes, render this ex- 

 cellent therapeutic aid somewhat misleading. 



The nitrogen metabolism has been variously studied in the treatment 

 of hypothyroidism (Magnus-Levy et al.). On account of the labor and 

 cumbersomeness of carrying out accurate nitrogen balance observations, 

 this procedure is of little clinical value. There is good experimental evi- 

 dence, however, for believing that changes in the nitrogen balance accom- 

 pany thyroid therapy. On several occasions, the writer has found a dis- 

 tinct gain in the amount of nitrogen retained in the body to result from 

 accurately controlled thyroid therapy in hypothyroidism. It is likely, 

 for reasons which cannot be entered into on account of brevity, that a gain 

 in the nitrogen balance regularly accompanies the renewed growth or 

 tissue regeneration caused by the thyroid therapy in subthyroidism. The 

 loss of nitrogen sometimes reported under such conditions is very likely 

 a. toxic loss except at the very incipiency of treatment when the "slack" 

 nitrogen of the body and the melting of myxedematous tissue may lead 

 to a preliminary increase in the nitrogen output. 



The blood glucose curve, though of some utility in the diagnosis of 

 hypothyroidism, is of little value in the treatment as it undergoes 

 oscillations which scarcely permit of definite analysis. There is, how- 

 ever, a general tendency of the blood sugar curve to become elevated 

 (hiring periods of thyroid medication in the case of cretins or myxedemics 

 (Janney ). 



Dietetic Treatment of Hypothyroidism. But very few observa- 

 tions in this regard have been reported. In view, however, of 

 the i>reat importance of the thyroid for the regeneration and repair 

 of the body tissues as well as in growth, it is obvious that only a 

 therapeutic effect could be expected from thyroid medication when the 

 patient was on a suitable dietary. Frequently this diet is found to be over- 

 nch in protein, and deficient in fats and carbohydrates, on account of 

 efforts on the part of patient or physician to combat the accompanying 

 obesity. The results of an inadvised reduction cure in the presence of 

 hypothyroidism may ho serious. The patient, in an already weakened 

 state, may become so depressed and asthenic that many months of judicious 

 thyroid medication and dietetic care may be required for a restoration of 

 health. It is not justifiable to permit a high protein diet as experimentally 

 this has hcn-n shown to lay an added burden on the thyroid glano^ which in 

 hypothyroidism is already weakened in function. From prolonged meta- 

 hohc studies of the effect of various dietaries in cretinism, the writer has 

 come to the conclusion that a fairly high caloric diet of normal balance as to 

 carbohydrate, protein and fat is the most suitable in hypothyroidism. Such 



