In about 20 cases of exophthalmic goitre a limitation of the field of vision observed, which fluctuates with the vari ations other symptoms show. Bast and Wilbrand (Neurol. Centralb., July 15, '90).
Limitation of the field of vision does not belong to the clinical picture of ex ophthalmic goitre, and its presence, in the absence of material lesions of the brain, fundus or media of the eye, should suggest the co-existence of hys teria. Soucques (La Semaine Med., May 20, '91).
Case of exophthalmic goitre in a maid servant, 21 years old, in whom the pro trusion of the eyes was so great and the inability to close the lids so long-con tinued that both corneas ulcerated through, and removal of both eyes be came necessary, after which the general condition of the patient improved greatly. Griffith (Brit. Med. Jour., Aug. 20, '9S).
The protrusion may come on rapidly and may subside as rapidly, showing that it is due to congestion, perhaps associated with muscular relaxation. Later, it be comes fixed and is referable in part to accumulation of fat in the orbit. It is often greater on one side than the other, the right lobe being usually the more prominent. The right lobe of the thy roid, as has already been noted, is like wise usually more prominent than the left, and the conclusion almost forces itself on the mind that the two phe nomena are in some way related. It occasionally happens, however, that the larger lobe of the thyroid and the more protruding eye are on opposite sides. The failure of the lids to cover the eye ball prepares the way for ulcerations of the cornea, though it seems probable that the other influences come in, since the exposure alone is not always a sufficient explanation.
Sensory disorders are not characteris tic except those which are related to the general feelings of malaise. Many others occur in individual cases, but they are largely signs of concomitant neuroses.
Patients with acute Graves's disease usually grow thin and weak, while excess of phosphates and urea appear in the urine. On the other hand, in mild or even in rather serious cases the weight may remain unchanged or may even increase.
An interesting symptom in Graves's disease is rapid loss of weight occurring intermittently. Huchard (Journal de 111CA., Feb. 10, '96).
It is worthy of note in this connection that obesity, in otherwise-healthy per sons, is not always overcome by thyroid preparations, and that different persons react very differently as regards loss of weight. Toward the close of life in fatal cases, and even at an earlier period, a sort of cachexia may come on which obstinately resists treatment.
Alimentary glycosuria, characterized by the appearance of sugar in the urine within a few hours after taking grape sugar or glucose (the usual test-dose being 100 grammes) is relatively com mon among patients with Graves's dis ease, though this peculiarity is shared by the subjects of various other neuroses.
True diabetes mellitus is also thought to be relatively common among them, though, in fact, rare.
Feverishness (increased internal tem perature) may be present during acute stages, but by no means in proportion to the sense of heat.
Icterus, salivation, and digestive dis orders occur, though rarely, except for the diarrhea, which will be referred to separately.
Diseases of the gastrointestinal tract, diarrhoea, and vomiting belong to the symptomatology of Graves's disease, the former being especially common. The diarrhoea is usually not due to fermenta tive changes, but to anomalies of secre tion and peristaltic action, either based upon disorders of innervation or indicat ing the elimination by the intestine of some toxic substance. Sometimes the stools are simply liquid, sometimes they are peculiar in character. Cholesterin has been found in considerable quantity, and in the case of a patient of mine a number of whitish masses were excreted, the character of which was not ascer tained. Sometimes the stools are bloody, and in this and other respects one is re minded of the other forms of hysterical or "nervous" diarrhoea, which are so com mon. The hypersecretion is not much affected by opium.