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Categories: Uncategorized
Sources: 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 m
ch 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

thyroid gland.

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.