CLINICAL SYNDKOMES (STATUS THYMICUS, ETC.) 409 

 Timme's Multiglandular Syndrome 



Timme has postulated a multiglandular syndrome, which he has been 

 able to trace through from childhood to the third decennium. This syn- 

 drome should be differentiated from status lymphaticus, with which it is 

 liable to be confused. In it the role of the thymus seems to be compensa- 

 tory rather than primary. The syndrome is discussed in detail in the 

 chapter on Multiglandular Syndromes. 



Thus far the literature shows no comments on the described syndrome. 

 Its merit is the attempt to work out the sequence of endocrin interactions 

 in a given type of cases. It is quite probable that several such diagrams of 

 endocrin imbalance will be' drawn before we succeed in grouping even the 

 majority of these disorders. 



The Thymus in Exophthalmic Goiter 



For a long time Graves' or Basedow's disease was considered synony- 

 mous with hyperthyroidism. But now it is recognized that many 

 cases are examples of relative hypothyroidism. With this recognition has 

 come the discovery that the thymus is often involved in the syndrome and 

 that it seems to have an effect on the symptomatology. Thus Garre and 

 Capelle found an enlarged thymus in 95 per cent of the fatal cases of 

 exophthalmic goiter studied by them. Eddy collected reports on 240 cases 

 and found that the thymus was persistent or enlarged in 201 or 83.75 

 per cent. Others estimate the proportion at 60 per cent. Hart (/) even be- 

 lieved that there is a purely thymogenetic form of the disease. Halsted and 

 others have attempted to classify the symptoms into two groups according 

 to the predominance of the vagotonic or thyroid elements, or of the sympa- 

 thetic or thymus elements. This has proven difficult to carry through in 

 the present state of our knowledge. But many students of the thymus see 

 in the my asthenia, sometimes accompanying Graves' disease, the influence 

 of the reactivated thymus. 



On the other hand, such experienced observers as the members of the 

 Mayo clinic believe that if the thymus participates at all in the symptom- 

 atology of exophthalmic goiter, its role is a negligible one. These differ- 

 ences in opinion make necessary a critical study of every case of Graves' 

 disease until the contradictions presented in these divergent views have 

 been eliminated. 



In the first place, it is necessary to define the disease anew. And such 

 a definition should be expressed in terms of both pathological physiology 

 and pathological anatomy. Toward this end Plummer's contributions are 

 very helpful, for he limits the term, exophthalmic goiter, to those cases 

 which show, not only the traditional triad of exophthalmos, tremor, and 



