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Source: Disturbances Of The Heart
The presence of a well marked case of exophthalmic goiter is not
necessary for the secretion of the thyroid to be increased
sufficiently to cause tachycardia; in fact, an increased heart
rapidity in women often has hyperthyroidism as its cause. The
thyroid gland hypersecretes in women before every menstrual period
and during each pregnancy, and with an active, emotional, nervous
life, social excitement, theaters, too much coffee, and,
unfortunately today among women, too much alcohol, it readily gives
the condition of increased secretion; and the organ that notes this
increased secretion the quickest is the heart.
The tachycardia of a developed exophthalmic goiter is difficult to
inhibit. Digitalis is of no avail, and no other single medicinal
treatment is of any great value. The tachycardia will improve as the
disease improves. On the other hand, nothing is snore serious for
this patient than her rapid heart, and if it cannot be soon slowed,
operative interference is absolutely necessary. If the rapid heart
continues until a myocarditis has developed and a weakening of the
muscle fibers occurs, or dilatation is imminent or has actually
occurred, operative interference is serious, and most patients under
these conditions die after a complete operation, that is, the
removal of from one half to two thirds of the thyroid. In such cases
the only excusable operative interference is the graded one, namely,
the tying of first one artery and then another of the thyroid to
inhibit the blood supply to the gland in order that it may not
furnish so much secretion. If the heart then improves, a more
radical operation may be done without much serious danger. Therefore
the working rule should be that, if a heart does not quickly improve
under medical management, operative interference should not be
delayed until the heart has become degenerated.
If tachycardia is the only serious symptom present in a patient who
is considered to have hyperthyroidism, it may generally be
successfully treated by insistence on quiet, cessation of all
physical and exciting mental activities, more or less complete rest,
the absolute interdiction of all tear coffee or other caffein-
bearing preparations, total abstinence from alcohol, the restriction
to a cereal and fruit diet (the withdrawal of all meat from the
diet), the administration of calcium, as the calcium glycerophospate
in dose of 0.3 gm. (5 grains) in powder three times a day, and for a
time, perhaps, the administration of bromids. If the depressing
action of bromids on the heart is counteracted by the coincident
administration of digitalis, they will act only for good by quieting
the nervous system and more or less inhibiting the secretion of the
If a patient has exophthalmic goiter fully developed, absolute rest
in bed, with the treatment outlined above, should soon cause
improvement. If it does not, the operative treatment as advised
above should be considered. If myocarditis has been diagnosed, the
minor operations should be done if the patient does not soon
improve. The prolongation of the treatment depends on the condition
and the amount of improvement.
If the physician is in doubt as to whether or not this particular
tachycardia is caused by hyperthyroidism, the administration of
sodium iodid in doses of 0.25 gm. (4 grains) three times a day will
make the diagnosis positive within a few days. If the trouble is due
to hyperthyroidism, all of the symptoms will be aggravated; there
will be more palpitation, more nervousness, more restlessness, more
sweating and more sleeplessness. In such cases the iodid should be
stopped immediately, of course, and the proper treatment begun.
Next: Toxic Disturbances And Heart Rate
Previous: Paroxysmal Tachycardia Management