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December 14, 1918


JAMA. 1918;71(24):1998. doi:10.1001/jama.1918.02600500048008

Exophthalmic goiter has long been ascribed to a condition of hyperthyroidism despite the difficulties of interpretation which this hypothesis entails. Toxic symptoms, even including exophthalmos, can be induced by ingestion of large quantities of thyroid extract. This well established fact is, perhaps, the most compelling indication for the hyperthyroid theory. Nevertheless it has not sufficed to establish any acceptable or effective uniformity in the mode of treatment; and the dissatisfaction with the attempts to explain all the varied symptoms of exophthalmic goiter as the outcome of hyperactivity of the endocrine glands is manifest in current discussions of the pathogenesis and therapy of this malady.

Reviewing the criticisms of the theory of hyperthyroidism in relation to so-called exophthalmic goiter, Janney1 has reminded us that the typical exophthalmic goiter contains only from a fiftieth to a twentieth of the total active iodin present in normal thyroids; whereas more, not less, iodin