The Radium Treatment of Toxic Types of Goiter

Abstract

THE difference between the types of goiter amenable to radiation treatment and all other types lies in the fact that those in which radiation has proven to be of value are the types accompanied by an increased functional cell activity. In most of these cases there is also a proliferation of cells. Therefore, the problem presented is the problem of reducing the amount of secreting epithelial surface, whether it be contained in an adenoma or in a thyroid hyperplasia. We have also the problem of reducing the degree of hyperactivity of individual cells. There is an optimum point in thyroid secretion. Departure from this point, either upward or downward, leads to disease. While a small increase in thyroid secretion heightens all the vital powers and functions, a greater degree of increase has a profoundly poisonous effect on all body structures, these effects being particularly noticeable in the nervous system, the brain, and the glands of internal secretion. In dealing with hypothyroidism or hyperthyroidism, we are dealing simply with a departure from normal quantity in the secretion of the thyroid, the departure being either a lack of the necessary secretion, or an over-supply of the same secretion. In dealing with adenoma of the thyroid, we have introduced into the equation quite a different factor. We have here to deal with an increased activity of thyroid tissue, but the thyroid tissue in question is not normal. It is a more or less abnormal structure growing inside of a capsule, which, in turn, is inside of a thyroid gland. The tumor tissue produces a secretion which is incomplete, or otherwise abnormal in its manufacture. To a certain degree, it imitates normal thyroid secretion, but it exerts a more poisonous effect owing to the fact that it is not only excessive in amount, but it is also abnormal in chemical make-up. We have here to deal with a question of quality as well as quantity. In dealing with toxic thyroid, we are dealing with both increased proliferation of cells and increased activity of these cells. Such physiologic behavior suggests an irritating factor in the etiology of the disease, the search for which has been going on for many years. The knowledge now at hand, the most reasonable working hypothesis, is that micro-organisms brought into the gland through the blood, or lymph vessels, and acting directly on the thyroid epithelium are the principal etiologic factors. It is possible that the overgrowth of thyroid tissue may, in some degree, be compensatory. Thyroid secretion combats toxins and infections. An abnormally high amount of material, emanating from foci of low-grade infection, may call out an extra effort on the part of the thyroid infection-fighting mechanism and this, in order to protect the body as a whole, may lead to the overgrowth of the secreting epithelium which has this protective effect.