AFFECTIONS AS SEQUELE TO PATHOLOGICALLY EXAGGERATED THYROID SECRETION Dasedow's Disease. (Exoptithalmic Goitre; Graves's Disease) Basedow's disease is rare in infancy. According to Steiner there occurs one case in infancy to every fifty cases in adults.
Age and sex play a predisposing role in its etiology. In childhood most cases occur between the ages of eight, and fifteen years, only one case of two and one-half years having been reported. It increases in frequency at the age of puberty, and females are three or four times more frequently affected than males. Race also seems to have a bearing on the frequency of the disease, since the great majority of the cases occurs in Germanic nations rEichhorst). Patients suffering from goitre, palpitation of the heart, and alcoholism arc predisposed, the his:tory showing goitre, enlargement of the thyroid in the course of scarlet fever, angina, pertussis, and above all a lymphatic constitution; also rachitis, amemia and chorea. As a causative factor physical or psychic injury has frequently been mentioned.
Aside from these predisposing factors, many authors hold that a pathologically.- changed and exaggerated secretion of the thyroid is the cause of Baseclow's disease Moebius), which has also led to its differen tiation.
It is possible, however, that the sante injury which led to increased vascular thrills in Basedowis disease also causes the exophtlialmos through overfilling the retrobulbar blood-ves.sels, enlargement and increased secretion of the thyroid, Trousseau's spots, blushing with a sudden sensation of heat, profuse perspiration, and serous intestinal secretion. Irritation of the motor DCI'VeS, exaggerated vasomotor excitability, increased metabolism, would then be consequences of the same noxious influences, and exophthalmos, enlargement of the thyroid, tremor, and accelerated pulse would be symptoms of constitutional neurosis.
The disease usually commences with manifestations of vasomotor irritation. Palpitation, increasingly accelerated pulse, paroxysms of blushing and heat, dermographism and profuse perspiration, followed by excessive nervous excitability, restless sleep and irritable temper are the beginning manifestations of the affection. (Fig. 132.)
The thyroid is always enlarged in children in this condition, but it may not be possible to demonstrate it.
Tachycardia has been stated to be the first symptom in one-third of the cases, enlargement of the thyroid only in one-fifth.
The affection develops rapidly and may reach its climax in a few days or weeks (Soiling, Demme, Mueller). As a rule, the goitre does not attain large dimensions and reaches its maximum in four or at the most six weeks.
The heart is usually somewhat dilated, and at this stage the pulse beats are from 100 to 120, rarely rising beyond 150. The pulse beats are rather full and soft, the carotids jumping, and over the entire extent of the heart and thyroid there is a systolic, blowing noise. Arrhythmia of the pulse is not of frequent occurrence.
Exophthalmos is absent in about 20 per cent. of juvenile cases, and where it develops at all it is of a moderate degree and may easily escape observation. Lagoplithalmos with infrequent lid movements (v. Stellwag) occurs somewhat oftener than Graefe's symptom, which consists in drooping of the lids as the eyes are directed down ward. Insufficient conver gence, which, according to Moebitis, is not an infrequent occurrence in adults with Basedow's disease, has not been observed in children.
Tremor, too, is only ob served in exceptional ea.ses. Pseudoehorea of the hands, as well as genuine chorea, has repeatedly been observed in tbe beginning of the disease, but they disappear long before its termination.
Where tremor develops at all, it oceurs oftener than the true typical trembling ler), but only; quite exception ally in the shape of very shght twitching in rapid succession (Charcot; P. Marie).
There is pronounced ema ciation from loss of fat and albumen as the disease takes its course, the cause of which has been demonstrated by Magnus-Levy as the never absent metabolic increase, by instituting exact determinations of the respiratory gas changes. The elevated body temperature, amounting to 0.2 to 0.5° C. (Teissier), also corresponds to the increased metabolic changes. At the .,:ame time, the gastro-intestinal digestion is undisturbed, unless there are attacks of serous diarrheea which are often observed in Basedow's disease.