An Investigation into Those Factors Relating to the Etiology of Toxic Goitre

The object of this thesis has been to collect, corelate and discuss those factors which relate to the etiology of toxic goitre: to examine the theories held regarding its etiology and to submit evidence in support of the hypothesis that toxic goitre is a condition of general intoxication, dependent upon the existence in the patient of a previous neuroendocrinopathy which may be inherent or acquired, a condition analgous to the Graves' Constitution described by certain authors, and which requires an igniting stimulus - in the vast majority of cases one of psychic trauma, to set into flame its classical signs and symptoms. Evidence is also brought forward to support the existence of a precise relationship between the supra renal bodies and the thyreoid gland, the latter being stimulated by the secretion of the former, in part through the medium of the sympathetic nervous system, and in part by a direct influence upon the thyro-neural junction of the sympathetic nerve endings. As a result of the work certain other facts came to light regarding the iodine content of the blood, and considerable evidence is adduced that in its assay lies an index which may be of value in diagnosis - particularly in early or doubtful cases, and especially when estimated before and after the injection of .5 c.c. adrenalin hydrochloride 1/1,000 solution. Further, it has been shown that the iodine content of the blood bears certain relationships to the basal metabolic rate and that its estimation may be used with advantage to identify the potentially myxoedematous person, to assess the degree of recovery of thyreoid function where there has been operative interference, and as a useful clinical accessory in watching the progress of the disease. The investigations were carried out in the Wards of the Victoria Infirmary, Glasgow, the Biochemical and Pathology Departments of that Institution, and in the Department of Surgery, Glasgow University. The clinical material consists of a series of seventy eight cases of toxic goitre treated during the years 1935/1938 in the Victoria Infirmary, and examined during the past year and a half by the writer