The Exophthalmos of Hyperthyroidism: A Differentiation in the Mechanism, Pathology, Symptomatology, and Treatment of two Varieties: Part II

Abstract

B. THYROTROPHIC EXOPHTHALMOS The association of hyperthyroidism with morbid conditions of the pituitary gland and the demonstration that an ex­ ophthalmic variety of hyperthyroidism follows the injection of an anterior pitui­ tary extract has led to the opinion held today by not a few that exophthalmic goiter is the outcome of thyrotrophic ac­ tivity. Criticism of this view is justifiable for several reasons of which two only will be mentioned; namely, that the pres­ ence of an excess of thyrotrophic hor­ mone, constantly discernible in those con­ ditions associated with an increase, has not been found in thyrotoxicosis, and, secondly, that the experimental type of proptosis resulting from injections of pituitary extract differs markedly in its main features from that of thyrotoxicosis. Thyrotrophic hyperthyroidism, however, occurs in more than one form in man, and of these one is accompanied by a type of exophthalmos as nearly identical as can be with the experimental variety alluded to above. The close similarity of these two types indicates strongly the probable pathogenesis concerned in the develop­ ment of the human variety; hence the finding of an increased quantity of thyro­ trophic hormone in the serum of patients with thyrotrophic exophthalmos forms a not unexpected item of corroboration.