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Exophthalmic goiter, it is said, is, or may be indicated by four symptoms, tachycardia, exophthalmos, goiter, and tremor. Tachycardia is usually held to be the early, leading, or primary symptom, the other three trailing off in relative unimportance. Indeed, any one or two, perhaps three, of the four may be absent, and yet the real morbific Proteus be present, concealed and yet pathogenic by means of the one or two remaining.
Pathology of a serious or rational standing has really nothing to offer as to the cause and nature of the disease. The oculists have kindly shoved the problem off into the far country labeled "ductless glands," and it has been quizzically suggested that the exophthalmic principality of the quadruple-crowned and loosely joined grand-duchies, owes all its independence to a wondrous little, and little wondrous, "muscle of Müller," situated at the orbital fissure. How it is possible for these
GOULD GM, DURAND AC. EYE-STRAIN A CAUSE OF EXOPHTHALMIC GOITER. JAMA. 1910;55(25):2151-2152. doi:10.1001/jama.1910.04330250047013