THYROID EXCESS 189 



which produces excessive menstruation, and which is Hyper- 

 totally unassociated with any of the symptoms of andThe 18 " 1 

 exophthalmic goitre. This condition is most often seen gential 

 in girls about puberty, usually just before and during 

 menstruation. It may be that the excessive activity 

 is due to the incomplete functional development of the 

 ovaries ; but, whatever the cause, there is not infre- 

 quently menorrhagia. I have, however, seen this same 

 enlargement of the thyroid with amenorrhcea. This 

 paradoxical phenomenon is to be explained on the 

 supposition of ovarian insufficiency in these circum- 

 stances, and of an inability of the thyroid in some cases, 

 in spite of its enlargement, to meet the deficiency 1 . 

 When there is menorrhagia I have found that it can 

 always be controlled with calcium lactate. 



It is usually stated that with true exophthalmic goitre 

 amenorrhcea coexists. I have not been able to satisfy 

 myself that this is so until the metabolism has been 

 seriously disordered, and the increased quantity of 

 calcium which is being excreted by way of the urine and 

 faeces — a constant phenomenon in Graves' disease — is 

 so large that there is no excess for the ovaries to excrete 

 in the menstrual fluid. Generally, in the early stages of 

 the disease there is menorrhagia. Should a large body 

 of evidence eventually disprove this view it will be a 

 positive argument of great value that in Graves' disease 

 the secretion is perverted even if there be also an excess 

 of the normal. But in this matter, too, we must 

 remain in comparative ignorance until our knowledge of 

 the pathology of exophthalmic goitre is more definite. 



Helen Gurney 2 found amenorrhcea in 15 per cent, of 

 the cases analysed, but she makes no statement as to 

 the stage of the disease in her cases. Further, she says 

 that " in some cases it (amenorrhcea) appeared before the 

 disease and improved when the goitre developed ". The 

 same writer adds, " The effect of menstruation on 



1 See also article by the Author on ' The Disorders of Function ' 

 in The New System of Gynaecology, 1917. 



2 Gurney, Helen M., Brit. Med. Journ., 1915, vol. i, p. 924. 



