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The clinician knows that every one of the above-mentioned causes of increased brain-cell, adrenal, liver and muscle activity may cause an increase in the activity of both the normal or the enlarged thyroid; and lie knows only too well that in a given case of exophthalmic goiter the same stimuli which excite the brain, the adrenals, the liver, and the muscles to increased activity will also aggravate this disease.
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.
It relates to the phenomena of one of the most interesting diseases in the entire category of human ailments I refer to exophthalmic goiter, or Graves' disease, a disease primarily involving the emotions. This disease is frequently the direct sequence of severe mental shock or of a long and intensely worrying strain.
This whole train of deleterious results of body activation without action may be best observed and studied in that most emotional of diseases exophthalmic goiter. Exophthalmic goiter may result from long emotional or mental stress in those cases in which the thyroid takes the brunt of the strain upon the mechanism.
"I think I have found out the immediate cause of her trouble," he said simply, ignoring my suggestion. "What is it?" I asked eagerly. "I can't imagine how they could have failed to guess it, except that they never would have suspected to look for anything resembling exophthalmic goiter in a person of her stamina," he answered, pronouncing the word slowly.
Now, whatever the exciting cause of exophthalmic goiter, whether it be unusual business worry, disappointment in love, a tragedy, or the illness of a loved one, the symptoms are alike and closely resemble the phenomena of one of the great primitive emotions. How could disappointment in love play a role in the causation of Graves' disease?
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 the heart is normal the ventricles should hypertrophy with the increased work that they are under; and the blood pressure could increase for this reason. Later in exophthalmic goiter the heart muscle may become degenerated, a chronic myocarditis, and the ventricles may slightly dilate. At this time the blood pressure is lowered.
We can thus understand how either emotional strain or acute or chronic infection may cause either exophthalmic goiter or cardiovascular disease; how chronic intestinal stasis with the resultant absorption of toxins may cause cardiovascular disease, neurasthenia, or goiter.
In young women exophthalmic goiter often follows in the wake of a disappointment in love; in women, too, it frequently follows the illnesses of children or parents during which they have had to endure the double strain of worry and of constant care. Since such strains usually fall most heavily upon women, they are the most frequent victims of this disease.
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