Thyrotoxicosis

" Scire est nescire, nisi id me Scire alius sciret SPRING, 194:1. It would not be possible to deal at all fully with the scientific aspects of this subject in an article of reasonable length, and still less would it be possible to give a resume of the enormous literature that has grown up concerning it. My purpose is much simpler ; it is to present a record of personal experience and to offer suggestions as to the handling of these cases in general practice. The foundation for this study is a series of 488 patients operated on within the past seventeen years, and a considerable additional number seen but not operated on. Of these 371 were hospital cases, and 117 were treated privately. The doctor's first concern is with diagnosis. He must be prepared to meet with a few cases in men, and a very few in children. Of my 488 patients, 424 were women, 64 were men, and two were girls under eighteen. One was only ten. The ordinary case of thyrotoxicosis conforms so well to the familiar book picture that every doctor recognizes it at once. There are, of course, two types, with all gradations between them ; the intermediate cases, in fact, are numerous. On the one hand, there are the patients with classical Graves's disease, usually women under thirty-five years of age, with exophthalmos, fatigue symptoms, quick pulse, loss of weight, quick fine tremor best seen in the extended fingers, and a general enlargement of the thyroid gland which came on at the same time as the toxic symptoms. Serious cardiac damage is unusual and the psychic symptoms are often well-marked. At the other extreme is the woman between forty and sixty, who has had a nodular goitre for many years, B Vol. LVIII. No. 218.