Modern surgery, general and operative . is view is that Gravess disease may exist with-out detectable thyroid enlargement, but this objection loses force when werecall that the thyroid may be somewhat enlarged, though we cannot detectthe increase. It is probable in exophthalmic goiter that whether or not thereis an excess of thyroid products passing into the circulation, toxic materialsof some sort are formed in the gland and are taken into the lymph and real cause of exophthalmic goiter is not positively proved, but it seemsprobable that the disease is due to the action on the sympa
Modern surgery, general and operative . is view is that Gravess disease may exist with-out detectable thyroid enlargement, but this objection loses force when werecall that the thyroid may be somewhat enlarged, though we cannot detectthe increase. It is probable in exophthalmic goiter that whether or not thereis an excess of thyroid products passing into the circulation, toxic materialsof some sort are formed in the gland and are taken into the lymph and real cause of exophthalmic goiter is not positively proved, but it seemsprobable that the disease is due to the action on the sympathetic system oflarge amounts of thyroid material, of some poisonous product of thyroidactivity, or of some toxin the thyroid fails to destroy. In exophthalmic goiter the vessels of the gland are not dilated—in fact,they are usually smaller and less numerous than in a parenchymatous goiterof the corresponding size (Berry, on Diseases of the Thyroid Gland). Thesurface of the gland is smooth. On section, the cut surfaces seem solid and. Fig. -Exophthalmic goiter and total blindness fromprotrusion of eyes (Hansell). Exophthalmic Goiter 1237 very little colloid is visible. The enlargement is due to growth of the glandu-lar epithelium, either general or in localized areas, and this epithelial prolifera-tion may be induced by different exciting causes. In exophthalmic goiter the lymphatics within the lobules are usually ob-literated, but the lymphatics around the lobules are present in increasednumber and are of exaggerated size. Sometimes the thyroid becomes fibrous,and in such cases myxedema is apt to arise. In a typical case there are rapidpulse or tachycardia, protrusion of the eyeballs or exophthahnus (due to a col-lection of fat back of each eye), and enlargement of the thyroid gland or thyroid enlargement or exophthalmus may be absent—in fact, in somerare cases both are absent. The pulse-rate in most cases is from 90 to is present in at
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Keywords: ., bookcentury1900, bookdecade1910, bookpublishe, booksubjectsurgery
