Definition

A disease characterized by an exophthalmose, an enlargement of the thyroid, functional disturbance of the heart and vascular system generally, and said to be caused by disturbances of the secretion of the thyroid gland; or, to be specific, hyperthyroidism.

Etiology

This is a disease met with oftener among women than men, although some men develop a fatal affection of this order. There is no question but that the cause is enzymic shortage, allowing toxin poisoning; in this resembling alcoholism. Constitutional poisoning by alcohol is pronouncedly a nervous and physical trouble. Few cases, however, develop such a tumultuous action of the heart as occurs in goiter. There are very good diagnosticians who believe that it is a central lesion located in the base of the brain or in the medulla oblongata. The symptoms said to be produced by the administration of thyroid secretion are tachycardia, headache, sweating, and perspiration. These symptoms are very similar to those found in extreme cases of Graves' disease.

Symptoms

The disease is divided into an acute and a chronic stage. The acute disease arises very rapidly. The patient will become exceedingly nervous, the pulse running from 120 to 160. The heart is tremendously tumultuous, and there is a feeling of precordial oppression, approaching that of smothering in severe cases. The eyes have a protruding appearance. Patients are often suddenly seized with vomiting, and sometimes diarrhea. The thyroid gland is found very much enlarged and soft. The gastro-intestinal symptoms are pronounced. The rapid heart action is one of the most pronounced symptoms. The exophthalmos may be unilateral; that is, one eye may be more pronouncedly projecting than the other. In extreme cases it is impossible for the eyelids to close. The protrusion has been known to be so extreme as to dislocate the eye from its socket. This appears rare and exaggerated; yet the projection is at times more than one could imagine to be possible. In the foregoing I have given the usual etiology and symptoms. I shall now give my opinion and impressions in regard to the disease.

It is a pronounced case of toxin poisoning. The patients affected with this disease have been eating beyond their digestive limitations for perhaps months, and possibly years, keeping up a continuous putrefaction in the large intestine. In nearly all the cases I have seen there has been colitis. The absorption of toxins from the putrefaction, running over a long period of time, has brought on pronounced enervation and an excitable state of the heart and arteries. The arterial pressure is high, and the heart is tremendously overworked. As stated before, there is a decided similarity between this disease and alcoholic neuritis or delirium tremens. Both are caused from toxins--one from alcoholics plus the toxins from putrefaction in the bowels, and the other from simple toxin from putrefaction.

In Graves' disease or the disease under consideration, there is almost invariably a history of sex neurosis. The patient early in life has begun to practice self-abuse. Then, when maturity is reached, the excess in venereal excitement has been continued. The truth of the matter is that exophthalmic goiter is the culmination of several years of sensualism.

The fact that the thyroid gland becomes involved in the syndrome to such an extent that it appears to be causative is probably due to enzymic shortage in the gland, allowing a local toxin poisoning.

Treatment

This disease can be cured, if taken in time. Some of our best medical authorities declare that the seriousness of the symptoms warrants strong measures being carried out; hence they recommend ice to quiet the heart. The ice-pack is to be placed over this organ, and the application is to be continued through day and night until the heart is controlled. Then drugs are given to control the action of the heart. Serum therapy is recommended; also surgical treatment for the removal of part of the thyroid gland. I certainly would not recommend any of these remedies. A patient should be put to bed, and kept there perfectly quiet, away from all friends and family. No one is to come into his presence except the nurse. Water may be given as freely as there is demand--which will not be very often after the first day or two.

The bowels are to be washed out with copious enemas. If the weather is cold, and there is a tendency for the hands and feet to be cold, hot applications are to be placed to the extremities; but the patient is to be kept in bed, perfectly quiet, and nothing is to go into the stomach except water until the pulse-rate is brought down to ninety or below. By that time the tumultuous heart will have quieted down, there will be less bulging of the eyes, and the whole aspect of the patient will be that of a decided improvement. It may require a week or two, but no hesitancy should be felt in carrying out the instructions to the letter. It is far better to trust the patient in the arms of nature than to trust to remedies questionable in their character and certainly doubtful in their efficacy.

As soon as the patient is able to eat (and eating certainly should not be started until the symptoms are absolutely under control), several days should be spent on fruit--any kind of fresh fruit that the patient can enjoy--say, three days. Then three days more on fruit morning and night, with an ordinary meal at noon of meat or meat broth and salad, with a cooked, non-starchy vegetable or two, every other day; and the alternate days some form of starchy food in place of the meat or broth, with vegetables and salad. After that a reasonable amount of eating on the order of fruit for breakfast, starch and fruit for the noon meal, and the regulation dinner in the evening.