Our clinical study1 of exophthalmic goiter suggested an investigation of the involuntary nervous system. The manifestations of exophthalmic goiter may be divided into the metabolic disturbance measured by the basal metabolism, and the sympathomimetic symptoms (tachycardia, exophthalmos, polyrrhea, sweating, etc.). The latter have been so called because they may be produced by stimulation of the thoracicolumber division of the involuntary nervous system. Not all persons with sympathomimetic symptoms have elevation of the basal metabolism. To a clinical association of sympathomimetic symptoms and normal basal metabolism, we have applied the term "autonomic imbalance."2
Our clinical studies of autonomic imbalance failed to reveal the predisposing causes. The exciting causes may be divided into physiologic and pathologic. The most prominent physiologic factor is the sex epochs, particularly in the female, and the most frequent pathologic factor is foci of infection in the nasopharynx. Our patients showed considerable range in their symptoms:
LIEB CC, HYMAN HT, KESSEL L. A STUDY OF EXOPHTHALMIC GOITER AND THE INVOLUNTARY NERVOUS SYSTEM: VIII. A CLINICAL AND LABORATORY STUDY OF THE INVOLUNTARY NERVOUS SYSTEM. JAMA. 1922;79(14):1099–1101. doi:10.1001/jama.1922.02640140011004
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