440 KELSON W. JANNEY 



show exophthalmos and Stelwagen's sign, probably as a result of former 

 Graves' disease; moderate obesity, very flabby musculature. No portion 

 of thyroid gland is palpable in neck beneath lobectomy scar. Heart, 

 lungs, abdomen negative. Blood pressure 135/85; extremities and skin 

 cold and cyanotic. Pulse 76 ; temperature and respiration normal. 



Laboratory Data: Urine and blood count normal. Hemoglobin 70 

 per cent (Sahli). Differential blood count, lymphocytes 38 per cent, 

 large monomiclears 3y 2 per cent, polymorphonuclear leucocytes 55 per 

 cent, eosinophiles 1% per cent, basophiles % per cent, transitionals 



5 



EXTRACT u 



CjlUCOSET 



TDLEWW* 



10, 





T3.f. 



Ki<;. 20. JSIasked Hypothyroidism. Inability to gain nitrogen and weight on 

 abundant diet. (From Janney and Henderson, Arch. Int. Med., Vol. xxvi, pp. 297- 

 318, 1020, by permission). 



1% per cent. Initial basal metabolism 38 by small Benedict apparatus. 

 The blood sugar curve was decidedly abnormal. 



The case is of interest on account of the family history which suggests 

 a congenital defective thyroid function which may have predisposed to 

 the grave niyxedeina following lobectomy for Graves' disease. 



The course of the case under thyroid treatment with regular control 

 by the basal metabolism is an excellent example of the great aid of this 

 physical method in control of the treatment (see accompanying chart and 

 legend). As the general result of treatment, the dosage of thyroid extract 

 could be accurately determined; the basal metabolism was permanently 

 reestablished at the normal rate, the patient's health became practically 

 normal and she was able to carry out her duties in a highly satisfactory 

 manner. She still showed certain of the signs of hypothyroiclism, pallor, 

 transverse seaming of forehead, deficient eyebrows, coarse skin, etc. This 

 is rather to be expected in a case of seven years' duration with previous 

 intermittent and unsatisfactory treatment. 



