An extraordinary feature of thyroidal tissue is that when affected it may infrequently produce metastases, even to distant parts of the body. Thus cases are on record of benign goitre, with universal metastases, and, on the other hand, of numerous metastases without any noticeable thyroidal enlargement. They occur frequently in the osseous system, and in the lungs, and when the thyroid is the site of a colloid type of goitre. The same is equally true of the malignant growths of the same tissue.
The immediate results of a total removal of the thyroid, as by operation, are myxedema, or cachexia strumipriva, conditions which require a few weeks for development and which may be preceded by an acute mania. These conditions are indicated by anemia with weakness, defective circulation, swelling of the extremities, usually first in the fingers, the swelling being of a hard, inelastic type, and not pitting on pressure, appearing later in the face so that the features become altered. Later appear also muscular tremors, with tetanoid convulsive attacks. These results of thyroidectomy may be combated by feeding thyroid extract, or by transplantation of thyroid tissue from a sheep into the tissue of the body or into the abdominal cavity. While Horsley and others have been successful with the surgical procedure, it is usually now sufficient to resort to continuous administration of thyroid extract, this being indicated only in cases where thyroid activity is defective and being contra-indicated in instances of overactivity, such as exophthalmic goitre.
THYROIDITIS.
Thyroiditis as a more or less acute affection is occasionally noted, being due to one of the infectious fevers, or occasionally following dermatitis, local infections, etc. It may assume a hemorrhagic type and be followed by production of hematoma. It may also assume a suppurative type and lead to the formation of abscess. This, if impending, is always of a serious nature, as it is sure to be followed by local cellulitis, perhaps with serious pressure symptoms, and escape of pus along the deeper fascial planes into the thorax.
An acute idiopathic hypertrophy in children has been noted by the writer in one instance, in which the enlargement was rapid, occupying but a few days, and had already caused such compression of the trachea when the case was first seen that even a tracheotomy promptly performed did not serve to save the patient’s life.
Intra-uterine hypertrophy of the thyroid is also known. There are at least five cases on record of this condition following the administration of potassium chlorate to the mother during pregnancy. In one case reported the tumor attained a size sufficient to constitute a serious complication in delivery of the child.
Among the special symptoms produced by these acute affections are: difficulty of swallowing, which may lead to great thirst; head symptoms due to obstruction to the return circulation, with congestion of the face and epistaxis; while pressure upon the pneumogastric may cause nausea or vomiting. The treatment of such a case when seen early should consist of wet and ice-cold applications for several hours; but when seen later, especially if suppuration be already threatening, pus formation and its localization may be encouraged by hot applications, followed by free incision, thus relieving tension and evacuating pus.
Thyroiditis occurring in goitrous thyroids is usually referred to as strumitis, as the enlargement itself was formerly known as struma; it follows the exanthems and fevers, and may cause sudden and distressing complications.
TUMORS OF THE THYROID.
Aside from those thyroidal enlargements to be considered under the heading of goitre may be met tumors of congenital origin, especially the simple or complicated cysts, which may grow slowly or rapidly, or may not appear at all until puberty or adult life. An apparently innocent cyst may suddenly increase in size and produce serious symptoms, or hemorrhage may occur into it, or it may rupture, in either of which instances severe pressure symptoms will ensue. All cystic tumors of the thyroid should be enucleated, an operation usually easy of performance unless the collection be multilocular and extensive. If an entire thyroidal lobe be occupied by growths of this character it may be assumed that its function has been so much impaired that it should be completely removed.