. The endocrine organs; an introduction to the study of internal secretion . A B FIG. 22.—A case of endemic goitre (A) before and (B) after treatmentwith thyroid, (v. Brun.) by symptoms of hypothyroidism; not, as might have been expected, bythose of when the enlargementis the result of malignantcell-proliferation (carci-noma or sarcoma), the func-tions of the organ may stillbe carried on. It is indeeda significant fact in con-nexion with the genesis ofmalignant tumours, thatwhen in such cases thewhole of the thyroid isremoved by the surgeon,should there be any meta-static g
. The endocrine organs; an introduction to the study of internal secretion . A B FIG. 22.—A case of endemic goitre (A) before and (B) after treatmentwith thyroid, (v. Brun.) by symptoms of hypothyroidism; not, as might have been expected, bythose of when the enlargementis the result of malignantcell-proliferation (carci-noma or sarcoma), the func-tions of the organ may stillbe carried on. It is indeeda significant fact in con-nexion with the genesis ofmalignant tumours, thatwhen in such cases thewhole of the thyroid isremoved by the surgeon,should there be any meta-static growths elsewhere, in the liver, the usualsymptoms of cachexiastrumipriva do not showthemselves. The enlargement of thegland in endemic goitregenerally takes the formof a diffuse hypertrophy: the follicles enlarge and their epithelium pro-liferates : new follicles may also become formed. There is nearly always a 3. FIG. 23. —Section of thyroid from a case of endemic 50 diameters. Notice the enormous size ofsome of the colloid-filled vesicles. 34 The Endocrine Organs tendency for colloid to accumulate. This ultimately causes enormous dis-tension of the vesicles and flattening of their epithelium (fig. 23), whichmay eventually undergo almost complete degeneration. A characteristicdegeneration of the arteries of the gland has also been described. Whilst the above are the usual changes found in endemic goitre, manyexceptions are met with. One would expect the enlarged gland to yieldan excessive amount of secretion to the blood, but this appears not to be thecase, although endemic goitre is occasionally characterised in its early stagesby symptoms suggestive of hypersecretion and resembling some of thoseseen in incipient exophthalmic goitre (p. 37). More often these symptomsof hyperthyroidism are absent: generally from the first and alwayseventually, the appearances which show them
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