Page:On the pathology of exophthalmic goître.djvu/6

 often been pointed out before by others as well as by myself. The symptoms, in fact, are such as we might expect to be caused by over-activity in the gland as compared with those which we know are due to deficiency or loss of function.

Still further physiological evidence in favour of this view is afforded by the effects which are produced by overdoses of thyroid extract in cases of myxœdema and in healthy persons. Many illustrations of this have been given, so that it will be sufficient to take the remarkable case recorded by Béclère as an illustration. A woman aged 31, suffering from myxœdema, took by mistake 92 grammes of thyroid gland in eleven days. The symptoms which developed were tachycardia, rapid respiration, exophthalmos, brilliancy of the eye, transient tremor of the arms, rise of temperature, insomnia, polyuria, glycosuria, albuminuria, and partial paraplegia. Many similar cases have been observed, showing that the



symptoms of thyroid intoxication or thyroidism are similar to those of exophthalmic goître. Another important fact is the improvement which follows operations which are undertaken in order to diminish the secretory activity of the enlarged gland either by actual removal of a part of it or by ligation of some of the arteries which supply it. Great improvement has followed in some cases and recovery in others. I have recently seen a case which has been cured by iodine injections, a fibrosis having been set up by the iodine, which has cured the disease.

Still further evidence is afforded by those cases of exophthalmic goître, a considerable number of which have now been recorded, in which, owing to the development of fibrosis, gradually leading to loss of the function of the gland, the symptoms of exophthalmic goître have been replaced by those