THERAPY 193 



and so eonsumed by the organism, or because the supply of iodin was deficient 

 while the activity of the gland was especially active, thus leading finally to 

 hypertrophy of the organ, v. Bruns, in fact, observed a decided diminution 

 in the goiters after the administration of comparatively small doses, and 

 Ewald, Stabel, and others in Germany obtained similar results. Wells in 

 1897 compiled 584 cases of simple goiter which were treated with difi^erent 

 thyreoid extracts, of which cases 475, i. e., about 82 per cent., were improved. 

 Nevertheless, in my experience, the cure is never complete ; that is, the goiter 

 does not completely disappear, although v. Bruns reports this result in about 

 8 per cent, of his cases. As has been already stated, the best results are seen 

 in youthful individuals in whom the goiter has not existed for too long a time. 

 The older the patient and his goiter the slighter the changes which may be 

 observed in the gland in favorable cases even after four to six days of treat- 

 ment with thyreoid preparations. Usually, however, this becomes noticeable 

 only during the second and third weeks of treatment. A diminution in the 

 circumference of the neck of from 4 to 6 centimeters is frequent; greater re- 

 duction than this is exceptional. Even in these cases, after discontinuance of 

 the remedy relapses occur, so that small doses must be repeated from time to 

 time. 



I have the history of two girls, aged nineteen and twenty-one years re- 

 spectively, the circumference of whose necks after the use of thyreoid prepara- 

 tions was reduced in one from 37.6 to 35.1 centimeters, and in the other from 

 33.5 to 33.1 centimeters. Symptoms of thyreoidism did not appear. I must 

 not fail to mention that equally favorable results have been obtained with 

 thymus preparations by Mikulicz and Eeinbach. 



The conditions are very different in another disease which also implicates 

 the thyreoid gland: Graves' disease. In this affection enlargement of the 

 thyreoid, as is well known, is one of the three cardinal symptoms of the dis- 

 ease — goiter, exophthalmos, tachycardia. But here we are no longer dealing 

 with a vicarious or compensatory labor hypertrophy of the gland, but with an 

 active increase of its secretion, which leads to the phenomena of thyreoidism 

 occurring in the course of the disease. The use of thyreoid preparations in 

 this malady is contraindicated, even if we omit entirely from consideration the 

 fact that the cause of Graves' disease is not to be found in an affection of the 

 thyreoid gland alone. We know that its cause is multiform and that other 

 organs— as is shown by the cases without goiter — especially the sympathetic 

 nervous system, are implicated. As a matter of fact all cautious and unbiased 

 observers have been convinced of the complete failure of thyreoid therapy in 

 Basedow's disease (exophthalmic goiter). Indeed it has been noticed that 

 its use is not only useless, but often produces a decided aggravation of the 

 symptoms. 



Although we have up to this point discussed the administration of thyreoid 

 preparations only as true substitutiontherapy in diseases in which a disturb- 

 ance of function of the thyreoid can be demonstrated, yet the list of the uses 

 of the remedy has by no means been exhausted. We know of other dis- 

 eases, or disease groups, in which, based upon the pharmacodynamic action 

 of thyreoiodin, this remedy has been employed with more or less success. I 

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