It is certainly a satisfactory result in congenital thyreoaplasia if with continuous medication boys will reach the mental level of a normal boy of four to six years, and the physical development of sixteen to eighteen years. In acquired athyreosis, however, the success depends upon the stage of development attained prior to the on:set of the affection, which will not only be regained, but satisfactorily advanced. As a matter of course, the medication must be continued for life, with an occasional interruption of three to five days.
The fresh thyroid of Irish sheep is best suited for this medication, one or two pairs being prescribed for every other clay. The physician should personally point out the glands to the butcher, calling his atten tion to their varying size and to the necessity of fresh material from a healthy anitnal. They should be freed from their capsule, finely scraped and spread on bread with a little salt or the yolk of an egg.
The nearest substitutes are Merck's thyroidin tablets, containing 0.01 Gm. of thyroidin sive; the similar tablets of Burrows, 'Wellcome & Co. of 01 to 0.3 Gm. each; thyraden; iodothyrin; or thyroglobulin of Oswald. Other preparations which have also been recommended (hypo physis tablets, Fraenkel's thyreoantitoxin, potassium iodide and arsenical medication), have not stood the test of efficiency.
The diet should preferably consist of vegetables with a moderate use of milk and eggs (green vegetables preferred), and, above all, fruit.
While the ingestion of raw thyroids, even with the addition of oil, has not led to toxic manifestations (A. Czerny), the latter have been frequently observed after the use of the tablets, the toxic effect being caused by their metabolic or decomposition products. Thus, Bourneville, Immerwohl, 'Marlon, Vermehrer, have observed even fatal cases after only ten clays' administration, but it should be added that daily doses of four to six tablets were given without observing a gradual increase. More frequently still, s,ymptoms of "thyroidism " have been described, consisting in great unrest, palpitation, perspiration and vomiting, even genuine Basedow's disease. On the other hand, Becker reported a case of Ewakl, in which a child of two and one-half years took as many as 90 tablets of 0.32-1 (13. W. &.; Co.) at a time without any injury.
The best plan certainly is to commence with tablet of 0.3 or 1 or 2 tablets of 0.1 Gm. and to continue these small closes, until in the course of a few days there is a certain demonstrable effect.
To avoid relapses (Fig. 12(3) it is necessary to continue the treatment for life.