494 EMIL GOETSCH 



Results in a Number of Normal Subjects. They found that in normal 

 subjects the fasting blood sugar shows a minimum value of 0.09, a maxi- 

 mum of 0.12* and an average value of 0.10 per cent. In most normal 

 persons the ingestion of 100 gms. of glucose and 50 gms. of bread 

 causes no increase in blood sugar two hours or even one hour after break- 

 fast. Fasting hyperglycemia is of rare occurrence in hyperthyroidism, 

 whereas alimentary hyperglycemia lasting in some cases for four hours 

 after the ingestion of carbohydrate is invariably present. 



Summary. Fasting hyperglycemia is of extremely rare occurrence 

 in hyperthyroidism. Alimentary hyperglycemia following the adminis- 

 tration of 100 gms. of glucose and 50 gms. of bread was observed in every 

 case examined. ~No relation could be found between the degree of hyper- 

 glycemia and the intensity of glycosuria. Neither was it possible to 

 obtain any evidence of a relation between the severity of intoxication, as 

 measured by the percentage increase over normal of the basal metabolism, 

 and the occurrence of hyperglycemia. In a number of cases it was 

 found, however, that after improvement of the patient's condition by 

 resting or by operation the alimentary hyperglycemia was of a much 

 lower grade than that induced by the same test given before treatment. 

 In two cases of hypothyroidism no change was noted in the fasting 

 blood sugar after the administration of thyroid extract. 



Clinical Value of the Hyperglycemia Test. Although alimentary 

 hyperglycemia is commonly found in hyperthyroidism, it is in no sense 

 specific for this disease, nor is it proportional to the degree of thyro- 

 toxicosis since it is influenced by many other factors. Hyperglycemia 

 is, of course, known to occur in diabetes, in nephritis in which it may 

 reach 0.2 per cent (Myers and Bailey) and also in edema. It was 

 shown by Hamman and Hirschman that alimentary hyperglycemia may 

 occur even in normal cases, the blood sugar rising to 0.15 per cent. A 

 certain number of otherwise normal cases have a low renal threshold for 

 glucose so that sugar appears in the urine although the blood remains 

 below 0.14 per cent. They also showed that the blood sugar curve, in 

 hyperthyroid patients, after the ingestion of 100 gms, of glucose has to 

 some extent the high, sustained and prolonged features of the diabetic 

 type, whereas in normal persons under similar conditions there is only 

 a moderate hvpero'lycemia that rapidly subsides, the blood sugar remain- 

 ing below 0.15 per cent and again reaching the fasting level, or in many 



instances a still lower level, in from one to two hours. Hyperglycemia 



i i 



has been noticed also in cases of edema and in certain cases of arthritis. 



In view of the facts, then, that alimentary hyperglycemia, and even 

 spontaneous glycosuria is fairly common in hyperthyroidism; that hy- 

 porglycemia is found also in a number of other diseases and pathological 

 conditions; that the decree of hyperglycemia is not parallel to the degree 

 of thyrotoxicosis ; that these carbohydrate changes are not specific for 



