EXOPILTHALMIC GOITRE.—In the treat ment of this condition the various prepa rations of thyroid have been found more harmful than beneficial in many cases.
This would seem to sustain the opin ion expressed by M. Allen Starr, that if exophthalmic goitre is due to hyper activity of the thyroid gland—a theory first proposed in 1SS6, and which has gradually gained ground since then— there is every reason why the thyroid treatment should be avoided. The few cases of reported improvement from this treatment would not, in his opinion, bear critical investigation.
It is probable, however, that in certain cases thyroid gland may prove of value, as shown in some of the instances ported below, and that we are as yet in sufficiently informed to determine just where the remedy is applicable. It should certainly not be employed indis criminately, and judging from a review of recent reports as a whole the condi tion of the heart would seem to influence the action of the remedy.
Case by thyroid extract, with improve ment at first, followed later by deterio ration. The thyroid extract was reduced, then stopped, but the patient died three weeks later. There was great prolifera tion of the thyroid epithelium. H. Power (N. Y. Med. Record, Aug. 11, '94).
Nine eases, all markedly improved. In the majority the improvement was slow, though steady, but in only one did the exophthalmos disappear. Bogroff (Gaz. Heb. de la Russie Merid., Jan., Feb., '95).
In Graves's disease thyroid treatment contra-indicated. It is possible, however, that when the goitre seems to be the primary trouble some benefit may be derived from this agent. Senator and Mendel (Berliner klin. Woch., Feb. 3, '95).
Thyroid has no favorable influence, and is, indeed, likely to increase the dis comfort, or, where the symptoms had abated, to light them up again. Stabel (Berliner Min. Woch., Feb. 3, '95).
Successful case after the use of a quarter of a lobe eaten raw twice a day. Fergusson (Brit. Med. Jour., Oct. 20, '95).
Case in which to 2 drachms of sheep's thyroid daily before meals, small amounts of gland daily, then omitting use for ten days every three weeks, caused all symptoms to disappear except slight swelling and slight exophthalmos. Voisin
(La Sem. Med., Oct. 24, '95).
Cases in which the remedy aggravated the active symptoms. Dreyfus-Brisac and Beclere (La Sem. Med., Oct. 24, '95).
Three cases in which good results were obtained. Voisin (Revue de Therap., p. 728, '95).
Patients who have been treated with thyroid extract prior to operation seem to be more liable to heart-failure both during and after this proceeding, and one or two deaths have been attributed to this cause. Angerer (Miinchener med. Woch.. 21, '96).
Case of woman. 40 old, who had been treated unsuccessfully with arsenic. The action of the heart was tumultuous and the pulse-rate was 160. The tremor in the hands was so pronounced as to prevent the patient's continuance of work as a sewing-machine operator.
The woman received from a friend 120 tablets of thyroid extract, each of 10 grains, and took six of these daily. After the lapse of three months the patient appeared almost entirely well. Slight struma was still discernible, but exophthalmos and Oracle's sign had dis appeared; the pulse ranged from 90 to 96; the tremor in the hands was absent; and the roaring over the heart was no longer apparent. The patient herself felt perfectly well. Silex (Berliner klin. Woch., No. 6, '96).
Case apparently much benefited by the administration of thyroid extract. The ease had existed for a number of years, and thyroid enlargement has been quite distinct. After the thyroid extract had been given for about a week, the pulse had dropped from 110 to SO, and ever since then the patient has been much more comfortable. It was necessary, however, to take thyroid every few mouths. There had been no return of the enlargement except for a few days, while the patient had had a cold. Hal lock (Jour. Nerv. and Mental Dis., June, '96).