THYROID GLAND DISEASES

Greymouth Evening Star, 29 December 1934, Page 8

THYROID GLAND DISEASES

TREATMENT BY OPERATION. The series just published in the “British Medical Journal,” by Mr J. M. Graham and Dr. H. L. Wallace, of Edinburgh, of 125 consecutive cases of thyroid disease treated by operation is a further evidence of one of the most important advances in modern surgery (writes the Medical Correspondent of the London “Daily Telegraph.”) Toxic goitre, an enlargement of the thyroid gland, accompanied by a characteristic group of signs and symptoms, is unfortunately, a not very rare condition. It is often a disease of youth, but may occur at any age and in any degree, from a condition of what may be called mild hyper-thy-roidism to the severer forms, in which the eyeballs become prominent, the pulse-rate may be nearly doubled, and there are uncontrollable tremors, especially of the arms and hands. These and their accompanying anxiety, and self-distrust are due to an over-supply by the enlarged gland of its normal and very important internal secretion. If left untreated they may produce chronic invalidism, and finally, owing to the immense amount of extra work imposed upon the heart, of definite cardias failure. For a long time this condition was regarded as beyond the bounds of surgery, and medical treatment consisted of enforced rest and the prescription of some form of iodine.

WHERE MEDICINE FAILED. ! There were, however, many failures on the part of medicine to afford permanent relief,'while it is probable that a great many cases, previously regard • ed as primarily diseases of the heart, were in reality due to an underlying over-activity of the thyroid gland. But the earlier attempts to deal with the situation’by surgical removal of part of the thyroid gland were not such as to recommend it, and the operation mortality was very high. This was largely due to ignorance of the chemical reactions involved, an unwise choice of anaesthetic, and a failure to realise the importance of careful preoperative preparation and the selection of the right moment at which to operate. Intensive research led to a new surgical approach to the problem. Thanks largely to the pioneer work in this country of Sir Thomas Dunhill and others, the surgical removal of the diseased thyroid gland—or, rather, of the greater portion of it —has now been finally established as a relatively safe, and often the only life-saving method of treatment. Briefly the new method consists of a period of treatment by rest and iodine medication lasting from ten days to about three weeks, a gentle induction into anaesthesia by means of some suitable narcotic or soporific, and a careful choice, in the case of each patient, of the particular anaesthetic used, whether local or general. There can be no doubt at all of the complete cessation of symptoms that follows in a very large proportion of cases treated in this way. The tremors and anxiety disappear, the pulserate returns to normal, and the rested heart acquires strength again and its usual regularity. , Thus, in the series recorded by Mr. Graham and Dr. Wallace, 63 per cent, of their patients reported themselves as entirely free from symptoms, and able to carry out their usual employment without any effort. Another 23 per cent, reported that they were well and fit for work, although they still showed slight evidences of hyperthyroidism.