HYPOTHYKOIDISM 433 



a regimen seems also to be indicated on a, priori grounds in order to supply 

 all the tissue "Bausteine" needed for a resumption through aid of thyroxin 

 of normal nutrition and growth processes. 



Thyroid Transplantation. Although thyroid transplantation has been 

 attempted by scores of investigators, not a single permanent result has 

 been reported to the writer's knowledge. The grafted glands may, as did 

 Bircher's early case in 1889, indeed relieve the symptoms of myxedema 

 temporarily but the grafts gradually become absorbed. Every conceivable 

 location in the body has been tried in vain. Considerable experimental 

 research has demonstrated that although autotransplantation may succeed, 

 yet heteroplasty, i. e. f the donor being of a different species, or even homo- 

 transplantation, i. e., transplantation using two individuals of the same 

 species, fail with regularity. This has been accounted for by Enderlen 

 and Borst and others as due to individual differences in the molecular con- 

 figuration of the tissue proteins. This seems indeed possible as Emil 

 Fischer's researches have demonstrated the possibility of each individual 

 having protoplasm differing chemically. 



Interesting observations on thyroid grafting have been made by Man- 

 ley and Marine who found that homographs of the thyroid lasted much 

 longer if grafts and hosts were iodinized. One is here reminded of the 

 favorable effect of thyroid substance on tissues growing in vitro (Carrel), 

 an unique example of the controlling influence of the thyroid on growth 

 of tissue. Thyroid transplantation must unfortunately still be regarded 

 as in the experimental stage and is not recognized as a clinical therapeutic 

 method at the present time. 



Surgical Treatment. Surgical treatment may become indicated for 

 large, cystic or degenerated goiters, or in the presence of pressure symp- 

 toms. Careful judgment should be exercised in advising removal of 

 thyroid tissue in the presence of hypothyroid symptoms as cachexia strumir 

 priva may result. The mortality of strumectomy in the hands of skillful 

 operators has been reduced to a minimum. The details of indications for 

 operation and technic are beyond the limitations of the present work. 



Illustrative Cases of Hypothyroidism 



Hypothyroidism in Children. Case No. I960, boy of 12. Mother is 

 myxedemic; had an initial basal metabolism of 19 per cent; was cured 

 by administration of thyroxin. An older brother has a saddle nose and 

 swellings of the under eyelids, but a normal basal metabolism, normal 

 growth, and no other symptoms of hypothyroidism. Patient was regarded 

 as being in perfect health, making no complaints whatsoever; was ex- 

 amined at request of mother. Present weight (October 24, 1919) 84% 

 Ibs. On questioning, it was found that the boy was a little dull at school 



