THE THYEOID GLAND AND ITS DISEASES 477 



The Epinephrin Hypersensitiveness Test (Goetsch) for 



Hyperthyroidism 



It has been shown as a result of abundant physiological research by a 

 number of investigators, such as Eppinger, Falta, Rudinger and Hess of 

 the Viennese School, by Asher and Flack (a) in Berne, and by Cannon and 

 Levy in this country, that in hyperthyroidism experimentally produced 

 and in a few instances of clinical hyperthyroidism, the sympathetic nervous 

 system is hypersensitive to epinephrin chlorid, and in states of clinical 

 hypothyroidism or after thyroidectomy in animals there is an increased 

 tolerance to injections of epinephrin. Applying this knowledge to a study 

 of approximately 500 patients suffering with disorders of the thyroid 

 gland, it was found by Goetsch (&) (c) (1918, 1920) that the patients with 

 hyperthyroidism l uniformly showed a remarkable sensitiveness to small 

 doses of epinephrin subcutaneousiy administered. This hypersensitive- 

 ness usually expressed itself in rather marked increase of blood pressure 

 and pulse and in exacerbation of the clinical signs and symptoms char- 

 acteristic of the disease. All cases of hyperthyroidism, whether pro- 

 duced by exophthalmic goiter, adenoma, puberty hypertrophy and hy- 

 * perplasia or diffuse adenomatosis of the thyroid gland, were verified by 

 careful histological study of all the operative material with especial ref- 

 erence to the occurrence of mitochondria as criteria of functional activ- 

 ity (Goetsch (a), 1916). As a, result of studies by Goetsch (b) (c) (d) on 

 this subject a clinical test for hyperthyroidism was evolved. This test al- 

 ways confirms and usually establishes the diagnosis of hyperthyroidism. 

 When positive the test is an indicator of hypersensitiveness of the sympa- 

 thetic nervous system. There is a small percentage of clinical conditions 

 which give a more or less positive reaction, and which are not dependent 

 upon definite pathological change in the thyroid gland. However, the test 

 is positive in all cases of hyperthyroidism. Furthermore, of all the 

 diseases which may possibly be associated with a hypersensitive sympa- 

 thetic, hyperthyroidism is by all odds the most common. In the pres- 

 ence of a negative response to the test one can state definitely that hyper- 

 thyroidism is not present. To be able to differentiate even to this extent 

 is of great value in the diagnosis of obscure cases. 



The epinephrin hypersensitiveness test is regarded as mildly posi- 

 tive when, after the injection of 0.5 c.c. of 1 to 1000 epinephrin chlorid 

 (adrenalin chlorid Parke, Davis & Co.) solution a rise of about ten 

 points in pulse or in systolic pressure or in both is obtained, and certain 

 clear-cut subjective and objective signs and symptoms characteristic of 



1 In this chapter "hyperthyroidism" is used to include the Graves' syndrome. ^ For 

 discussion of the justification of such usage, see discussion of etiology of Graves' dis- 

 ease,* p. 305. 



