On the Prognosis of Secondary Symptoms and Conditions of Exophthalmic Goitre

Abstract

It will thus be seen that exophthalmic goltre is by no means a harmless malady; but, of the eleven who died, the death can only be attributed to Graves's disease in two-namely, those which died suddenly; for sudden death is always cardiac; and, as the patients had suffered from palpitation, it is only fair to assume that the same cause as set up the palpitation, in some way was the reason of the sudden death.In the mitral regurgitant case, the mitral disease seemed more related to the antecedent rheumatic fever than the exophthalmic goitre.With regard to the treatment, Jane A., who did best of all the cases, had no treatment; Alice M. benefitted considerably from the local' application of iced water; Ellen E. ' and two are liable to neuralgia; in many cases, no doubt, these points were not asked, for it may be taken that the usually stated association with neurotic tendencies is true ; four cases, at least, had menstrual irregularities, and one patient stated that the exophthalmos was greater during the periods. The temperature was slightly raised in some cases (it was so in one in which the report does not mention the fact), and the pulseis accelerated out of proportion to the rise of temperature. The palpitation is usually the first symptom to appear (in two cases, it had existed all the patient's life); the enlarged thyroid and exophthalmos come second in order in about equal proportions, the exophthalmos being last rather more frequently than the other; as arule, all these symptoms come on within a few weeks of each other.The case of Alice M. G. is especially interesting, for I learn that tlie two sisters referred to also have exophthalmic goitre. Although it is not so well brought out as it should be in these abstracts, several of the patients suffer from wasting. In some cases, the eye s painfu4; but whether that is due to the conjunctivitis, or to the tension of the lids caused by the protrusion, is not stated.I have grouped all the above facts together, because they are all known to be frequent accompaniments of exophthalmic goitre; but the second group of conditions to which I would direct attention is that of the lymphatic system. Four of the twelve cases died within the hospital; one of these four died from heart-disease,.and, of.the remaining three, all suffered from some affection, of the lymphatic systel; thus, in Charlotte S., the thymus was persistent, and Peyer's patchqs were particularly well marked; in Mary M., the thymus was elarged and persistent, Peyer's patches and the solitary follicles of the whole intestine were much swollen, injected, and very prominent, and t* intestine itself was considerably injected; in Eliza T., Peyer's patches at the lower part of the ilem were of -a dark livid character, cntrasti_ g most strongly with the surrounding intestine, which was injectd.

Znacaj klinickih i biohemijskih parametara za predvidjanje remisije u bolesnika sa Graves-ovom bolescu lecenih medikamentnom tirosupresivnom terapijom

“…Veruje se da je kod ¼ pacijenata, pogotovo kod onih sa blagim oblikom bolesti, hipertiroidizam bio samoograniĉavajući, trajući jednu ili više godina, nakon ĉega bi pacijent spontano uspostavljao eutiroidno stanje. U jednom od nekoliko dobro dokumentovanih izveštajaobjavljeno je da je neleĉena tireotoksikoza kod 7 od 12 pacijenata završila smrću proseĉno za 3,5 godina od poĉetka bolesti, a da su ostali pacijenti preţiveli bez terapije 82,105. Procenjeno je da je u prošlosti mortalitet neleĉenog hipertiroidizma bio do 11% 82,105.…”

“…U jednom od nekoliko dobro dokumentovanih izveštajaobjavljeno je da je neleĉena tireotoksikoza kod 7 od 12 pacijenata završila smrću proseĉno za 3,5 godina od poĉetka bolesti, a da su ostali pacijenti preţiveli bez terapije 82,105. Procenjeno je da je u prošlosti mortalitet neleĉenog hipertiroidizma bio do 11% 82,105. Srećom, smrtnost od hipertiroidizma je danas vrlo retka, ali ima teških, na vreme nedijagnostikovanih, neleĉenih sluĉajeva koji završavaju smrtno.…”