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March 22, 1924


JAMA. 1924;82(12):970-971. doi:10.1001/jama.1924.02650380038017

The problems of the management of toxic goiter, thyrotoxicosis or exophthalmic goiter are singularly difficult of satisfactory solution. The dominant derangement is in the domain of the involuntary nervous system. Among the cardinal clinical symptoms are included tachycardia, exophthalmos, goiter and tremor, along with such less characteristic manifestations as diarrhea, sweating and palpitation. To these must be added the now readily measurable elevation of the basal metabolism. Confusion frequently creeps into the consideration of toxic goiter because some of the phenomena mentioned occur also in so-called autonomic imbalance, a disturbance of the involuntary nervous system by no means regularly attended with augmented basal metabolism. Aside from a variety of attempts at drug therapy, including iodin in one compound or another, and treatment by rest, the most commonly instituted remedial procedures in recent years have involved surgical ligation of thyroid blood vessels, partial thyroidectomy, and exposure of the thyroid gland to