AFFECTIONS OCCURRING AS SEQUEL/E TO INSUFFICIENCY OF THYROID FUNCTION (Dpthyreosis; HypothyrensiR) Jaunin, Marjan, Guinon, and Brissaud have communicated observa tions of stmple myxecilema in infants, which were explained as light, incomplete cases of athyreosis and insufficient glandular function, imme diately reacting to organotherapy. They were equivalent to those frequent occurrences of slight endemic cretinism which have recently been studied in detail by Magnus-Levy. To this category also belong the numerous observations so cleverly analyzed by Hertoghe, edited and translated into German in 1900 by J. 1-1. Spiegel berg, which however have so far not met with sufficient attention. I have also met with several such cases and found that their mental des;elopment was less impaired than the physical. They proved to be genuine cases of hypothyreosis or dysthyreosis. Furthermore, Brissaud and Lorain have described several groups of infantilism as sequelte to congenital hypothyreosis which correspond exactly with Hertoghe's analyses.
The fact that all these affections of the thyroid are amenable to organotherapy, with frequent brilliant success, is bound to arouse keener interest in them than they have so far commanded.
Disturbances of physical and mental development, such as occur combined in the highest degrees of athyreosis, have been observed as consequences of inflammatory thyroiditis, congenital inferiority of the thyroid in families affeeteil by chronic alcoholism, syphilis, and cachectic processes, especially in regions where endemic cretinism prevailed. These cases have often been observed as family affections. Sometimes the thyroid cannot be demonstra ted during life; in other cases it is apparently, considerably atrophied and degenerated.
In favorable cases thyroidism with im paired intellect is restricted to slight or exten sive dwarfish structure owing to the skeleton persisting in the stage of very juvenile de velopment, corresponding to two to five years of age.
The diagnosis can be made at the first glance from the typical facial expression, the myxcedematous soft parts and mucous mem branes, the short neck, the clumsy bodily structure, the distended abdomen, the infan tile genitalia, physical apathy, and subjective sensation of cold. The following illustrated cases will serve better than long explanations.
Alfred S. (Fig. 131), eleven years and four months old.* Parents and two brothers thoroughly healthy. Dentition occurred, but slowly. Was able to walk at the age of one year. Mental develop ment normal. The only unusual features, consisting in bloated appear ance and insignificant growth, became apparent in the fourth month.
From the fifth year growth was more and more retarded, but he attended school with good results and is now attending a high school. Never was ill with the exception of a slight attack of measles. The thyroid was apparently demonstrated on the right side (?) having the size of a date kernel. Height 113 cm., circumference of head 54 crn. The radiogram of the hand corresponds about to that of a three-year-old child and, aside from other peculiarities, shows that all epiphyseal ends of the diaphyses are separated by a thin, distinct bone lamella against the epiphyses, as has been described by Dieterle.
Other excellent illustrations will be found in Volume III of Zuber's "Traite des maladies de l'enfance," p. 292.
Fig. 131 will serve as an illustration of Brissaud's type, all soft parts being round and full, the head enlarged, physical development arrested, with infantilism.
Lorain's type, on the other hand, is distinguished by slight skeletal structure, with greatly elongated extremities,. a narrow, small head and a girlish build correspond ing to a much lower age. Here again there is pronounced arrest of growth owing to much re tarded skeletal development.
The cases of formes frustes in endemic cretin ism, as well as the fully developed eases, likewise show their homogeneous character with hypothy reosis in their course and therapeutic reaction.
The. variations in the pathological pictures are occasioned by the peculiarities of the patients, While the inflammatory atrophy and almost com plete absence of thyroid function lead in a pre viously healthy child to the symptom-complex of simple myxcederna described by Jaunin, Marjan, Guinon and others, children of degenerated fami lies in regions with endemic cretinism will present the picture of very slight mental debility, slight arrest of physical and mental development in the shape of very slight cretinism or formes frustes. In families with a history- of considerable alcohol ism, syphilis, tuberculosis and rhemnatic affec tions, which have persisted for several generations, the lightest cases of dysthyreosis in the shape of infantilism have been observed by Hertoghe, Brissaud and Lorain. But they are all amenable to thyroid medication, as the illustrations will show.
The prognosis is favorable, even though physical progress is often more resistant to treatment than the mental.
The treatment consists in continuous administration of small doses of thyroid or its substitutes.