Clinical survey of fifty cases of exophthalmic goitre: with special reference to the pathology, symptomatology, and treatment of the condition

Abstract

(1) Exophthalmic goitre is a disease which is becoming more common.(2) A remarkable rise in the death rate from this condition has occurred in the last few years. This is probably an aftermath of the war.(3) The maximum death incidence is 45-55.(4) The sex ratio of Great Britain is probably more than 10 females to 1 male. There is a constant death ratio of about 10 to 1 for all ages found over a long series of years; and male cases have a worse prognosis than female cases.(5) The cause of exophthalmic goitre is unknown. A combination of psychic and toxic factors occupies a prominent aetiological position. Recent evidence favours the theory of dysthyroidism; the possibility of a diathesis has been brought forward.(6) The presence of a loud prolonged systolic murmur over the superior thyroid vessels at the upper poles of the thyroid gland is of diagnostic importance.(7) The blood pressure - the systolic blood pressure is increased, the diastolic lowered; the pulse pressure is increased.(8) Glycosuria is common in this condition.(9) Amenorrhoea would appear more common than menorrhagia.(10) The nervous picture is not one of pure anxiety and apprehension. The patient is often very self - confident, her outlook optimistic, her speech incisive, her manner vivacious.(11) Mania, melancholia: and delusional insanity may be the end result of the condition. The central nervous system is the chief seat of post-operative changes.(12) Less widely known symptoms are good appetite when ill, changes in the nails, and an increased tolerance for cold accompanied by a decreased tolerance for heat.(13) Rest is the sheet anchor of treatment.(14) The administration of iodine produces definite improvement within 48 hours, and marked improvement within seven days. There is a fall in the pulse rate, nervousness is diminished, regression regression of the exophthalmos and loss of the stare occur, the thyroid becomes smaller and usually firmer, the basal metabolic rate falls, and the patient increases in weight.Contrary to the general opinion the writer believes that the role of iodine in this condition is not merely for pre- operative treatment. In doses of potassium iodide gr. 4 daily, it can be used for months with advantage, and no signs of increased hyperthyroidism ensue.(15) It is questionable if the exophthalmos ever totally disappears.(16) The use of insulin in this condition is still to be proved.(17) X -rays and radium are disappointing; they decrease the size of the gland without exercising more than a slight effect on the general symptoms.(18) Operative interference is still associated with such a definite mortality that it should not be lightly undertaken.