Exoplithalmic goitre in its various de grees results from a perversion of the function of the thyroid gland. Horsley (Brit. Med. Jour., Dec. 5, '96).
Graves's disease results from some form of specific muscle-poisoning pro duced by the thyroid gland. Lemke (Minch. med. Woch., No. 15, '96).
The thyroid body produces a normal and an abnormal iodothyrin that are, possibly, identical as to chemical anal ysis and to experimental medicine, but that are different in their biological re actions. The one, physiological, acts as a regulator of the nutritive changes; the other, abnormal, acts as a disturber of these changes, and is capable of setting up the cachexia of exophthalmic goitre. This theory explains the change of an ordinary goitre into an exophthal mic goitre. Gauthier (Revue de Med., Mar. 10, 1900).
Series of eases of acute thyroidism fol lowing the therapeutic use of iodine. In another series there had been mild symptoms of Basedow's disease, which were enormously aggravated by the use of iodine. Belief that iodine acts by causing an absorption from the gland of certain toxic substances contained in it. The toxic symptoms develop in only a small proportion of cases, owing to indi vidual idiosyncrasies. Robert Breuer (Wiener klin. Woch., July 19, 1900).
Chlorosis has been frequently assigned as a cause of Graves's disease, and indeed the two affections are often enough seen in conjunction. But the fact that so careful a student of chlorosis as Van Noorden asserts that he has not been able to detect any such relationship shows that it cannot be a very important one. On the other hand, the impossibility, at present, of assigning the true cause for every outbreak of Graves's disease is well illustrated by the history of an acute case, which ran its whole course while the patient was under observation in Van Noorden's clinic, and apparently free from unfavorable influences.
Infectious diseases sometimes lead to thyroiditis, and thus to Graves's disease.
Uterine fibroids, disease of the nasal tract, and disease of the intestinal tract —the latter serving perhaps as a source of ptomaine poisoning—are occasionally partial causes which should be remem bered during efforts at treatment.
Partial atony of the large intestine is a frequent and important complication, perhaps even a cause, of exophthalmic goitre. Federn (Wiener Klinik, Mar., Apr., '91).
Two cases in which attention to the toilette and antisepsis of the bowels proved extremely beneficial: a feature sustaining the relation between Graves's disease and intestinal toxemia. Minor (?1ed. Record, Dec. 2, '99).
Graves's disease is an autointoxication from the alimentary canal, due to a peculiar inability properly to digest nitrogenous food. Such poisons in the blood may overstimulate the thyroid gland, and may occasionally lead to atrophy of the gland and to myxcedexua. Thomson (Med. Record, Jan. 13, 1900).
Pathology. — The account of the pathological anatomy must be, for the present, confined to the description of the appearances observed in the different organs, and, as most of these are second ary, they can be dismissed briefly. Of great importance, however, are the changes noticed in the thyroid gland, and for these the results reached by Hamig may be accepted as expressing the best modern views. In common with the majority of observers, Hamig found a diffuse parenchymatous hyperplasia of special form. This hyperplasia may lead to the formation of nodules, and it may be attended by an alteration of the secre tion such that thin albuminous secretion is formed instead of the colloid. The cylindrical cells of the gland may un dergo vacuolization, which is to be taken as a result of activity of secretion.
Other forms of goitre occur in Graves's disease, but they arise from other causes, such, for example, as those which lead to the endemic variety, and the changes found in them are not characteristic of the exophthalmic form of goitre.
There are slight histological differ ences in different cases, such that some times the arrangement of the cells is dif fuse, while in other cases small, ill-de fined follicles are formed, and in others the tissue takes on an embryonic char acter. Again, the epithelium may be of slender form and the arrangement gland ular.