Exophthalmic Goiter Research Articles

The Association of Carcinoma of the Thyroid Gland and Exophthalmic Goiter

The Association of Carcinoma of the Thyroid Gland and Exophthalmic Goiter

TREATMENT OF EXOPHTHALMIC GOITER IN CHILDHOOD

THAT THE MOST efficacious method of managing exophthalmic goiter in childhood still remains debatable is evidenced by a review of the literature. Opinions vary from those favoring immediate surgical treatment in all cases1to those advocating only medical management.2Still others believe that radiation procedures produce as good results as surgical intervention.3 As to roentgen ray therapy, there is nothing conclusive in the literature to indicate its importance in childhood. One is naturally wary of its use in growing children and young adolescents. Those in favor of operation have advanced the following arguments: Psychic maladjustment may occur incident to the enforced invalidism of prolonged nonoperative treatment. Because of extended periods of absence from school and play, the child cannot keep pace with his comrades, and thus serious behavior problems may develop. The maintenance of a prolonged state of subacute hyperthyroidism may militate against normal growth

USE OF PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER

FOR THE first time in the history of surgical treatment of the thyroid, it is now possible to operate on all types of toxic goiter with comparatively little risk. While effective in the preoperative and postoperative care of exophthalmic goiter, iodine has not been effective in lowering the operative risk in cases of advanced toxic adenoma. Thiouracil and propylthiouracil (thiourea derivatives), on the contrary, are extremely beneficial in preparing both exophthalmic goiter and toxic adenoma for operation. Thiouracil, because of its tendency to cause toxic reactions and, especially, granulocytopenia, has been largely abandoned for the much safer propylthiouracil. From a study of 170 cases of hyperthyroidism in which treatment was with propylthiouracil during the past two years, some conclusions have been reached. 1. After several months' treatment, patients with advanced multiple toxic adenoma with a serious cardiovascular condition may be operated on with almost as little risk as patients with

AN ATTEMPT TO EXPLAIN THE ANOMALOUS ACTION OF LUGOL’S SOLUTION IN EXOPHTHALMIC GOITER1

In a sekies of investigations extending over a number of years we have followed a certain working hypothesis, although we realize that other hypotheses have been followed by other investigators. We consider a goiter a thyroid gland enlarged by compensatory hypertrophy and therefore capable of producing more thyroglobulin than the normal thyroid. The distinction of diffuse and adenomatous goiter often fails due to the finding of minute or hidden adenomas in goiters previously classified as diffuse. Kocher, of Berne, Switzerland, would not allow iodine used on his goiter patients for fear of making them all hyperthyroid but Plummer, of the Mayo Clinic, dosed his patients with Lugo’s solution and demonstrated its anomalous action in lowering the basal metabolic rate in exophthalmic goiter. We have shown that thyroglobulin from untreated goiters has a low thyroxine content (Cavett, Rice and McClendon, ’35).

USE OF MASSIVE DOSES OF VITAMIN A IN THE TREATMENT OF HYPERTHYROIDISM

INVESTIGATIVE work during the last decade and a half has established the close interrelationships existing between hormones and vitamins in their effects on the same organs of the body (19). Of considerable interest is the relationship between thyroxine and vitamin A, concerning which an extensive literature has developed abroad but strangely enough comparatively little in this country. The antagonism between the thyroid hormone and vitamin A was first suggested a half century ago (39) and confirmed between 1930 and 1939 by extensive experimental work in animals. For the present report the effects of massive doses of vitamin A (200,000 to 400,000 i.u. daily) in hyperthyroidism were tested in two patients. One was a woman with menopausal exophthalmic goiter of moderate severity complicated by essential hypertension; the second, a rather severely toxic hyperthyroid woman. Routine studies such as urinalysis, blood count, blood sugar and electrocardiogram were performed in both patients; the metabolic rate an...

The treatment of acute appendicitis superimposing severe exophthalmic goiter

The treatment of acute appendicitis superimposing severe exophthalmic goiter

Post-operative Occurrence of Exophthalmic Goitre

Post-operative Occurrence of Exophthalmic Goitre

CHANGES IN THE PROMINENCE OF THE EYES IN VARIOUS THYROID STATES1

FOLLOWING thyroidectomy for exophthalmic goiter there frequently occurs an increase in the prominence of the eyes even though the patient's gross appearance suggests improvement in the exophthalmos. This observation was reported by Soley (3) in 1942 and (4, 5,) 1944, and confirmed by Dobyns (2) in 1945. As a sequel to studies described elsewhere we have studied by actual measurements the changes in the prominence of the eyes in other pathologic thyroid states during the course of various kinds of treatment. METHOD As previously described in another communication (2), the eyes of these patients have been measured with the Hurtel exophthalmometer. All measurements were made by the same observer who used the same instrument which was set at the same interocular setting for any one patient. The measurements were made as nearly as possible at the same time of day (about noon). The present study is a continuation of a former one in which several thousand measurements on the eye were made. Methods thus were well...

HEREDITARY EXOPHTHALMIC GOITRE—REPORT OF ELEVEN CASES IN ONE FAMILY1

HEREDITARY exophthalmic goitre is frequently encountered, and, yet, the presence of the disease in more than three members of one family is uncommon. Romberg (55) was the first to record the familial occurrence of exophthalmic goitre when in 1851 he reported its presence in twin sisters, twenty years of age. Withusen (71), eight years later, was the first to suggest a hereditary factor in this disease but he was unable to substantiatehis impression. In 1871 Solbrig (60) described the disease in a woman and in her eight year oldson. Four authors (44, 54, 59, 72) have reported families each with six members afflictedwith the disease. The family we present has eleven members with exophthalmic goitre. Thisfamily was described by Morrison (44) in 1928, at which time only six members had developed the disease. Inthis communication a hereditary study of exophthalmic goitre and otherdiseases occurring in this family ispresented. Complete case histories were obtained on those members with evidence of thyroid diseases.

Exophthalmic Goiter in Males

Exophthalmic Goiter in Males

The Effect of the Active Thyroid Substance on Metabolism and Other Functions in Guinea Pigs

Summary.Different preparations of dried thyroid from normal mammals and human beings and from cases of simple goitre have the same metabolic effect when given by mouth in equivalent daily doses based on the iodine content to mature male guinea pigs, accustomed to the metabolism determinations under standard conditions, while in exophthalmic goitre the iodine of the gland becomes less active.A partly purified product, elityran, also shows the same effect, while pure thyroxin, even when given subcutaneously is definitely less active. No difference was observed between the activities of thyroxin when given by mouth or subcutaneously.The metabolic effect of α‐dinitrophenol given by mouth reaches a maximum in about an hour and falls again rapidly while that of thyroid preparations takes two days to develop and by administration each day reaches a more or less constant level, maintained throughout the period of administration.Administration of iodine or di‐iodotyrosine reduces the metabolism raised by every day injections of thyreo‐stimulating hormone (artificial “Basedow”) and causes a regression of the histological and cytological “Basedow” symptoms in the thyroid gland, but has no effect on the hyperthyroidism brought about by feeding thyroid preparations.Refractoriness to the thyreo‐stimulating hormone was not observed in our case.The quantitative relation between dose and metabolic effect of dried thyroid preparations was studied on 44 animals. On 9 of these no well defined metabolic level could be obtained. The 35 animals showed a fairly regular relationship. The average resting metabolism of the guinea pigs was 100.1 ± 3.4 ml O2/m2/min. The increases were for 0.15 mg J/m2/day 17 ml O2/m2/min., for 0.25–29.0, 0.50–35.7 and 10.00–50.4. This corresponds to an approximately straight line relation between log dose and the absolute rise in metabolism.

Exophthalmic goiter after thyroid medication.

Acta Medica ScandinavicaVolume 121, Issue 2-3 p. 171-178 Exophthalmic goiter after thyroid medication. KNUD BRØCHNER-MORTENSEN., KNUD BRØCHNER-MORTENSEN. Department III (Medicine) the Kommune Hospital, Copenhagen (Chief Physician: Poul Iversen, M.D.)Search for more papers by this author KNUD BRØCHNER-MORTENSEN., KNUD BRØCHNER-MORTENSEN. Department III (Medicine) the Kommune Hospital, Copenhagen (Chief Physician: Poul Iversen, M.D.)Search for more papers by this author First published: January/December 1945 https://doi.org/10.1111/j.0954-6820.1945.tb06877.xCitations: 5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume121, Issue2-3January/December 1945Pages 171-178 RelatedInformation

Exophthalmic Goiter Developing after Treatment with Thyroid Preparations.

Exophthalmic Goiter Developing after Treatment with Thyroid Preparations.

RECENT ADVANCES IN PHYSIOLOGY OF THE THYROID AND THEIR CLINICAL APPLICATION

In times past there was much discussion of such questions as the differences between exophthalmic goiter and toxic nodular goiter. More recently it has been generally agreed that the differences in the history and the pathologic picture of these variations of hyperthyroidism are probably due to such factors as the age of the patient, the duration of the disease, the number of times acute exacerbations have occurred and the history with respect to intake of iodine, etc. From the functional point of view, most students of such disease have been content to differentiate between hyperthyroidism and hypothyroidism, and have bent their efforts toward elucidation of the causation and the physiologic manifestations of these abnormal functional states. A salient fact in physiology of the thyroid has been the influence of iodine on the function of the gland. This relationship has not been easy to interpret. It seemed fairly certain that the

THE DIETARY FACTOR IN THE ETIOLOGY OF PERNICIOUS ANEMIA

Excerpt Addisonian pernicious anemia is known to develop in accordance with genetic, racial, climatic and geographic determinants. The hypothesis that the disease is of dietary origin has been adva...

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

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.

LOCALIZED MYXEDEMA IN ASSOCIATION WITH HYPERTHYROIDISM

Localized myxedema is comparatively rare in dermatologic practice. Attention was forcibly drawn to this fact when in checking the statistics of the Skin and Cancer Unit of the New York Post-Graduate Medical School and Hospital for the past five years (1938 to 1942 inclusive), covering over 525,000 admissions, it was found that there was no case reported. Recently a patient has been admitted with localized myxedema of the tuberous variety associated with exophthalmic goiter. Since the cause of this disease is still unknown, with theories ranging from endocrine imbalance1to a more specific thyroid dysfunction,2it has been deemed advisable to report this case to stimulate interest in this dermatomedical problem. REPORT OF A CASE History.—H. W., a white man aged 30, a patient of Dr. John D. Currence, entered the New York Post-Graduate Medical School and Hospital on May 28, 1943 for roentgen

THIOURACIL

Since Plummer¹in 1923 introduced Lugol's solution for the treatment of exophthalmic goiter, iodine has been a routine agent in the preoperative management of these patients. However, in spite of its proper use there still remains a group of cases in which there is serious surgical risk. These patients are very toxic, having had the disease a long time. A large thyroid gland and a high basal metabolic rate usually are present. Widespread visceral strain is evident, as shown by great weight loss and at times cardiac complications. Preoperative improvement of these patients beyond the state obtained by the use of Lugol's solution and the usual supportive measures is desirable, but until recently no effective measures were available. Therefore these patients continued to cause the physician anxiety during the forty-eight hour postoperative period, and many of them required multiple stage operations to avoid severe reactions. Recently a new group

INTERMITTENT CLAUDICATION RELIEVED BY THYROIDECTOMY; A CASE REPORT

Excerpt An analogy has been frequently drawn between angina pectoris and intermittent claudication. Indeed much evidence has been brought forth to show that the pain is produced by a similar mechan...

PROGRESSIVE EXOPHTHALMOS IN TOXIC DISEASE OF THE THYROID GLAND

Exophthalmos has been recognized as a phase of the syndrome of hyperthyroidism literally since the recognition of the disease, as the nomenclature of exophthalmic goiter shows. Persistent or progressive post-thyroidectomy exophthalmos has been recognized as a possible undesirable and a potentially serious sequel of the operation almost from the time the surgical treatment of hyperthyroidism was introduced. The successful therapy of postoperative exophthalmos, however, is little more than a decade old, and intensive study of the problem of both preoperative and postoperative proptosis has been carried out for an even shorter time, so short a time, in fact, that Means's¹statement in 1942 that "a new specialty of endocrinologic ophthalmology is a-borning" seems unduly optimistic. <h3>CAUSATION OF EXOPHTHALMOS ASSOCIATED WITH HYPERTHYROIDISM</h3> Statements concerning the clinical aspects of exophthalmos are widely divergent. Paulson²and Cattell³could find no correlation between the severity of the hyperthyroidism and the degree