GOITRE Flyperplasia of the thyroid, which is usually partial, is termed goitre. It is of frequent occurrence in goitre regions, even in children, while sporadic eases are relatively rare. Goitre usually begins to appear at the time of puberty, but must often enough be referred back to the period of fetal life, in which cases we have to deal with congenital goitre. The ages of 642 strumous boys in Demme's practice were as follows: 37 up to 1 month 59 from 2 to 12 months 35 from 12 to 4S montl.
S3 from 4 to 7 years from S to 10 years 100 from 11 to 13 years 1S4 from 14 to 15 years These figures show the great frequency of occurrence in the first year of life and from the eleventh year onward.
The affection slightly preponderates in the female sex.
There is a deviation in the nature of infantile goitre from that in adults, inasmuch as fibrously degenerated goitres are rare, while follic ular and cystic goitres, or both mixed, preponderate, and colloid goitre is hardly ever observed.
Aside from bilateral goitre which permeates the gland in demarcated tumors, there occurs, according to the relative size of the thyroid lobe, a tumor in unilateral goitres which is usually situated on the right side. Besides, however, there occur isolated nodules, emanating from the accessory thyroids or the median lobe.
The symptoms are the same as in the adult. Manifestations of dis placement occur more frequently in infants, owing to their shorter neck, which is often provided with considerable adipose tissue, to the width of their numerous blood-vessels, and to the softness of the tracheal cartilage.
In large goitres, involving the entire width of the anterior cervical region, inspiration is stertorous with easily occurring dyspmea in physical efforts or excitement; speech is hoarse and rough, and interrupted by sibillating sounds. Smaller, unilateral goitres generally take a symptom less course. Grave manifestations of suffocation, such as occur in the retrosternal, fibrous or pedunculated goitres of adults, are exceedingly rare. Severe dyspncea may occur in metastatic strumatitis the course of typhoid, infectious diseases and septic processes which lead to rapid swelling of the gland and abscess formation. Furthermore, follicular or cystic goitre becomes a source of danger, if it compresses or encircles the trachea from both sides. In that ease there may be softening of the tracheal cartilage with following impaction and secondary bronchitis or broncho-pneumonia. This may lead to a sudden kinking of the carti lage with consequent rapid death.
Goitre and cretinism stand in the closest possible relation to each other. The very fact of both occurring endemically on the same soil points to it, as does the frequency of goitre in cretins and its ascendency. On the other hand, cretinism is in the first place dependent upon deficient thyroid secretion. It is perfectly intelligible, therefore, that the most severe endemic as well as so-ealled sporadic cretinism, or myxidiocy, should be accompanied by- absence or atrophy of the thyroid. While
goitre, however, is rarely, absent in the anaranesis of cretins, it is never present in myxidiocy; and while a considerable number of cretins have goitres, there exist numerous individuals afflicted with the largest goitres whose intellect is not impaired. The reason is that in the latter individuals the remaining part of the thyroid which has not been involved by the goitre is sufficient to ensure their physical and mental well-being.
From this it follows that goitre only leads to mpandenia, tux idiocy, or cretinism if all or nearly all of the glandular tissue has become incapable of function, while the largest goitre, as long as there is still a normal remnant of thyroid tissue left with normal secretion, will present only local symptoms.
The etiology is the same as in the adult. In all probability the affection is due to a causative factor contained in the drinking water of goitre regions, which resists boiling. There seems to be a predisposition to hyperplasia of the thyroid (Virchow) in early childhood which may probably depend upon the relatively large size and great vascular supply..
The diagnosis is simple. Goitre is distinguished from congestion or simple hyperplasia of the thyroid by the fact that only certain parts of the gland are attacked, or by- the shape and consistency of the tumor. Tumors of the lymphatic glands, cysts of the salivary glands, and bronchi ogenous tumors are differentiated by their localization, and are not frequent in children (Iffieke).
The prognosis is favorable, except in cases of struma which tightly encircles the trachea, or of retrosternal fibrous strums, which, however, is very rare.
Tile treatment is non-operative in the majority of cases. It consists in administration of iodine in any form, in small and smallest doses.
There are in the first place the various thyroid preparations, which will be specified later when treating of myxcedema and myxidiocy. According to Bruns, they have an excellent effect and include the con sumption of actual thyroid. Von Eiselsberg considers the iodine preps ration, equally efficacious, among which are potassium iodide, sodium iodide in small quantities of 0.05 to 0.2 Gm. daily, syrup of ferrum iodide, iodipin and sajodin. The latter is readily taken by children. Externally, local inunctions with potassium iodide ointment are applied, or iodine tincture is applied with a brush. Besides, the IISC of iodine waters is recommended, while a stay at the sea-coast will serve as an adjuvant to the internal treatment.
Internal medication will probably cure 90 per cent. of infantile goitre cases or remove all complaints Kocher), but should be repeated from time to time in view of possible relapses which not infrequently occur. Surgical treatment, which is dealt with in surgical text-books, does not belong to this chapter.