See also:term applied to a swelling in the front of the
See also:neck caused by enlargement of the
See also:thyroid gland . This structure, which lies between the skin and the anterior syrface of the
See also:pipe, and in
See also:health is not large enough to give rise to any
See also:external prominence (except in the pictures of certain artists), is liable to variations in
See also:size, more especially in
See also:females, a temporary enlargement of the gland being not uncommon at the catamenial periods, as well as during pregnancy . In goitre the swelling is conspicuous and is not only unsightly but may occasion much discomfort from its pressure upon the
See also:windpipe and other important parts of the neck . J . L . Alibert recorded cases of goitre where the
See also:tumour hung down over the
See also:breast, or reached as low as the
See also:middle of the thigh . Goitre usually appears in early
See also:life, often from the eighth to the twelfth
See also:year; its growth is at first slow, but after several years of
See also:comparative quiescence a sudden increase is
See also:apt to occur . In the earlier stages the
See also:condition of the gland is simply an enlargement of its constituent parts, which retain their normal soft consistence; but in the course of
See also:time other changes supervene, and it may become cystic, or acquire hardness from increase of fibrous tissue or from calcareous deposits . Occasionally the enlargement is
See also:uniform, but more commonly one of the lobes, generally the right, is the larger . In rare instances the disease is limited to the
See also:isthmus which connects the two lobes of the gland . The growth is unattended with
See also:pain, and is not inconsistent with
See also:good health . Goitre is a marked example of an endemic disease .
There are few parts of the
See also:world where it is not found prevailing in certain localities, these being for the most
See also:part valleys and elevated plains in mountainous districts(see
See also:CRETINISM) . The malady is generally ascribed to the use of drinking
See also:water impregnated with the salts of lime and
See also:magnesia, in which ingredients the water of goitrous districts abounds . But in localities not far removed from those in which goitre prevails, and where the water is of the same chemical composition, the disease may be entirely unknown . The disease may be the result of a combination of causes, among which
See also:local telluric or malarial influences concur with those of the drinking water . Goitre is sometimes cured by removal of the individual from the
See also:district where it prevails, and it is apt to be acquired by previously healthy persons who settle in goitrous localities; and it is only in such places that the disease exhibits hereditary tendencies . In the early stages,
See also:change of air, especially to the seaside, is desirable, and small doses of iron and of iodine should be given; if this fails small doses of thyroid extract should be tried . If palliative
See also:measures prove unsuccessful, operation must be under-taken for the removal of one lateral
See also:lobe and the isthmus of the tumour . This may be done under
See also:chloroform or after the sub-cutaneous injection of
See also:cocaine . If chloroform is used, it must be given very sparingly, as the breathing is apt to become seriously embarrassed during the operation . After the successful performance of the operation
See also:great improvement takes place, the remaining part of the gland slowly decreasing in size . The whole of the gland must not be removed during the operation, lest the
See also:strange disease known as
See also:Myxoedema should be produced (see METABOLIC DISEASES) . In exophthalmic goitre the bronchocele is but one of three phenomena, which together constitute the disease, viz. palpitation of the heart, elargement of the thyroid gland, and protrusion of the eyeballs .
See also:group of symptoms is known by the name of "
See also:Graves's disease" or " Von
See also:Basedow's disease "—the physicians by whom the malady was originally described . Although occasionally observed in men, this affection occurs chiefly in females, and in comparatively early life . It is generally preceded by impoverishment of
See also:blood, and by
See also:nervous or hysterical disorders, and it is occasionally seen in cases of organic heart disease . It has been suddenly
See also:developed as the effect of fright or of violent emotion . The first symptom is usually the palpitation of the heart, which is aggravated by slight exertion, and may be so severe as not only to shake the whole
See also:frame but even to be audible at some distance . A throbbing is
See also:felt throughout the
See also:body, and many of the larger blood-vessels are, like the heart, seen to pulsate strongly . The enlargement of the thyroid is gradual, and rarely increases to any great size, thus differing from the commoner
See also:form of goitre . The enlarged gland is of soft consistence, and .communicates a thrill to the
See also:touch from its dilated and pulsating blood-vessels . Accompanying the goitr6 a remarkable change is observed in the eyes, which attract
See also:attention by their prominence, and by the startled expression thus given to the countenance . In extreme cases the eyes protrude from their sockets to such a degree that the eyelids cannot be closed, and injury may thus arise to the constantly exposed eyeballs . Apart from such
See also:risk, however, the vision is rarely affected . It occasion-ally happens that in undoubted cases of the disease one or other ofthe three above-named phenomena is absent, generally either the goitre or the exophthalmos .
The palpitation of the heart is the most
See also:constant symptom . Sleeplessness, irritability, disorders of digestion, diarrhoea and uterine derangements, are frequent accompaniments . It is a serious disease and, if unchecked, may end fatally . Some cases are improved by general hygienic measures, others by electric treatment, or by the administration of animal extracts or of sera . Some cases, on the other
See also:hand, may be considered suitable for operative treatment . (E .
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