The Protein Content of the Cerebrospinal Fluid in Myxedema

Abstract

Measurements have been made of the concentration of protein in the spinal fluid3 in myxedema, before and after the administration of thyroid extract. These measurements are summarized in table 1. They show two things:1. In most of the cases, the protein concentration was high during the period of myxedema.2. In all but two cases, a well marked drop in the concentration occurred as the basal metabolism approached normal ( fig. 1), following the administration of thyroid extract. In the two that showed no decrease, the protein content was normal to begin with.It may be seen from table 1 and figure 1 that there were marked variations in the concentration from patient to patient, during the period of myxedema. These variations bore no relation either to the severity of the disease or to the degree of depression of the basal metabolism. There were also definite but less marked differences in the levels to which thyroid feeding depressed the protein content.These levels, in all but the first two patients, were within normal.limits (20 to 45 mgm. per 100 cc.).The change in protein concentration occurs gradually and may not be complete until some time after the basal metabolism has reached a

Papilloedema in Myxoedema

“…2 Elevated spinal fluid protein has been reported in myxoedema as long ago as 1928. 4 In a report by Thompson et al, 13 of 17 myxedematous patients demonstrated elevated CSF protein, all but 2 of which returned to normal when thyroid replacement was administered. 4 The exact aetiology of the increased CSF protein level is unknown, but is thought to be due to altered blood brain barrier permeability.…”

“…4 In a report by Thompson et al, 13 of 17 myxedematous patients demonstrated elevated CSF protein, all but 2 of which returned to normal when thyroid replacement was administered. 4 The exact aetiology of the increased CSF protein level is unknown, but is thought to be due to altered blood brain barrier permeability. 1,2 Myxoedema must be considered in the differential diagnosis of a patient with elevated ICP and papilloedema, especially with a history of thyroid disease.…”

Temporary and Permanent Myxedema Following Treated and Untreated Thyrotoxicosis 1

“…She improved on gradually increasing doses of Armour's thyroid extract. The albuminuria disappeared and the protein content of the spinal fluid decreased markedly on this medication (9). Four grains daily, however, produced symptoms of thyroid intoxication, viz., nausea, vomiting, precordial and epigastric pain and palpitation.…”

“…The cases treated by surgery, or by surgery combined with x-ray do not show this. In case 9 (table 1) and case 3 ( fig. 3), treated by subtotal thyroidectomy alone, and in case 1 ( fig.…”

“…Thyroid was omitted until December 1926, during which time her metabolism fell to minus 20 per cent, and her signs and symptoms became so pronounced that there was no doubt about the diagnosis of myxedema. She had the high protein concentration in her spinal fluid and the albuminuria so often present in this disease (9). She improved on gradually increasing doses of Armour's thyroid extract.…”