A British Medical Association Lecture ON HYPERTHYROIDISM
Authors: G. R. Murray
Journal: BMJ (1922)

IN the great majority of chronic diseases -we are called-upon to recognize and remedy deficiencies -of 'function resulting from morbid clhanges in individual organs' rhliese gtructural clhanges may produce alterations in thle size -of lthe orgain involved wli-clh may lhave meclhanical effects-as, for example, retention of urine due to enlargement of the prostate;gland.Mechanical effects of this kind are, however, in many cases of less importance than the functional disabilities.We have been apt in -tlhe past to pay great attention to both-gross and minute clhanges in structure witlhout fully appreciating their effects upon functional efficiency.We are learning by degrees to estimate more accurately the changes in function in a diseased organ-and -to realize their importance.Professor Hugh Maclean I has shown how this may be done in the case of the kidney by methods which are applicable in practice -and, wlhen taken into consideration along with the gymptonls, afford valuable information-as to the extent of impairment of function in cases of renal disease.In diseases of the ondocrine glands we have to consider the results not only of clhangesin their size and shape, but also of alterations in their functional activity wlhich may be either exalted or depressed.Enlargement of an endocrine gland may produce important effects owing to its anatomical position.Tllus; owing to its confined position a comparatively moderate enlarg,ement of the pituitary gland may produce the serious pressure effects known as "Ineighbourllood " symptoms, wlhiclh occur in some cases of acromegaly.In medicine we are more directly concerned with the results of changes in functional activity, which may be eitlher greater or less tlhan normal1 The results of too great functional activity are, in the case of the tlhyroid gland, only too well seen in cases of Graves's disease.The dire results of loss of function in tlle case of the suprarenal glands are familiar to all in the form of Addison's disease.In a forluer Britislh Medical Association lecture 2 a general account was given both of the methods of ascertaining, as far as possible, tlle plhysical condition of the endocrine glands aud of tlhe symptoms wlichl are due to changes in their func- tional activities.On this occasion tlle varieties and results of glandular overactivity, as illustrated by thle tlhyroid gland, will be considered as well as tlle principles whiclh slhould guide us in our endeavour to relieve thjerm.Overaction of a A woman, aged 39, was admitted to the Manchester Royal Infirmarv suffering from well-marked myxoedema.A sample of the twenty-four hours' urine was taken for examination on March 17th, 1920, before treatment was commenced.The patient was thefi gi-Ven one 21 grain tilryroid tabldid a dav.On March 21th the dose was increased to 5 grains, 'on April 9th to 10 grains, and finally, on'April 22nd, to 15 grains a day.The symptomns steadily diminished, and had prakctically disappeared wben anotlier samnple of the urine was taken on May 7th, after treatment for fifty days.-Dr.Wilite found the-amount of nitrogen from urea was increased from 3,501 mg. a day-in the first-sample to 6,948 mg.a day in the second, or-to almnost -exactly double the amount.The nitrogen from ammonia, creatinin, and urie, acid was[32o6]