[Anders (Jour. Amer. Med. Assoc., July 10, '97) says: "There can be no question that the evidences of cardiac disturbance constitute a really serious defect. and perhaps the only one in the thyroid treatment." He goes on to say, however, that 'the relation of mere al buminuria or actual nephritis to myx redema is not definitely known. On the other hand, it should be pointed out that the symptoms of Bright's disease have been observed to appear after the ac complishment of a cure by thyroid feed ing, in cases which no urinary phenom ena had been present during the course of myxoedema." This is certainly a, very rare occurrence and not one to be con sidered in the use of the drug.
Telford Smith (Lancet, vol. ii, 853, '97) has lately drawn attention to one of the disturbances resulting from this treat ment which should be watched for: "1 have found that during thyroid treat ment this rapid growth of the skeleton leads to a softened condition of the bones, resulting in a yielding and bend ing of those which have to bear weight; and as cretins under treatment become much more active and inclined to run about this tendency has to be guarded against. The bending takes place most markedly in the tibia and fibula, the in creased size of the ends of these bones at the ankle and knee being very notice able." WILLIAM OSLER and RUPERT NORTON.] The use of thyroid extract is only per missible when the patient can be kept constantly under observation, because of the severe and sometimes dangerous symptoms which it produces. Zarubin (Archiv f. Dermat. uu. Syph., B. 37, H. 3, '96).
Case of cretinism in a girl, 14 years of age, in which the thyroid-gland treat ment was instituted and followed by a very slow improvement mentally and a much more marked one physically. After undergoing the treatment at ir regular periods during about nineteen months, her temperature suddenly rose to 104° F., her pulse to 160, and respira tion became so short and thick that it was only with difficulty they could be counted. At this time she was taking 6 grains of thyroid extract daily. Medica tion was immediately stopped, but her condition remained the same, with one remission of temperature and pulse-rate, during two days, when, on January 22d, at 1 o'clock in the afternoon, she died. S. H. Friend (Med. News, Dec. 4, '97).
Caution must be exerted in the use of thyroid medication, for, while it is all powerful for good in suitable cases, it is.
not without ill effect in poorly-selected eases or in overdoses. It is hest to be gin with 5-grain doses daily and increase gradually to 15 grains daily in divided doses. A rise of temperature to one de gree above normal, an increase of the pulse-rate of more than twenty beats per minute, or any gastrointestinal dis turbance indicates that the dose is too large and must be reduced. F. A. Dodge (Northwestern Lancet, Oct. 15, .9S).
Case in which, at the age of 2 years and S months, the patient was in the condition of well-marked cretinism. The child seemed normal for the first four months of life, at the end of which it contracted whooping-cough lasting four months, and then it was seen to be ab normal. The origin of the cretinism attributed to the attack of pertussis. The effects of thyroid treatment upon the bodily and mental condition were re markably rapid and complete. A few months later, however, death occurred in a malignant attack of measles. II. O. Nicholson (Archives of Pediatrics, June, 1900).
Many methods have been suggested and tried for administering the thyroid gland, but the best and only practical one is by the mouth. The gland may be used raw or cooked, or prepared with glycerin as an extract, or in powder, tab let, or pill form. The surest and safest form is the tablet as prepared by one or other of the large wholesale drug firms (Parke, Davis & Co.; Frazer, Armour, and others). These tablets are not all of equal strength; so that in treating a ease it is better to use but one make than to change from one to another. The dose varies from '/„ grain once or twice a day in infants, up to 5 grains t. i. d. in adults. till all symptoms of cretinism have dis appeared; the drug may then either be omitted entirely for from three to six weeks, when symptoms of cretinism al most always recur, and treatment must be resumed, or doses of 5 grains every week or ten days may be persistently taken, and thus all evidences of return ing cretinism be avoided. It is, perhaps, better after the first period of treatment has been successfully carried out to omit all treatment till some of the old symp toms again appear, and then to note care fully just how much thyroid is required to extinguish these; in this manner it is easier to estimate just the dose required from time to time to stave away any sign of the disease.