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The activity of the thyroid gland is controlled by the hormone of the pituitary gland. The thyroid gland may be inactive or excessively active. Inactivity of the thyroid may result in the condition called cretinism which is associated with a deficiency of the thyroid gland in early childhood, and the condition called myxedema which comes on later in life. The person with myxedema has a typical face with puffy eyelids, and an apparent lack of interest in what is going on. The skin is dry and rough, the hair coarse, brittle and dry. Because the tongue and throat are swollen, the speech is slow and slurred.
Since the condition is lack of thyroid material, the treatment includes the giving of thyroid, and the dosage is adjusted according to the need of the patient and his response to the drug.
The lack of sufficient secretion from the thyroid gland during early life, as mentioned previously, results in delayed development which is called cretinism. If a child develops normally and then begins to show evidences of lack of thyroid the case is called “acquired hypothyroidism“. The condition may appear as a failure of the thyroid gland to grow or as a result of failure of the pituitary gland to stimulate the thyroid by sending the pituitary secretion necessary for this purpose. The latter failure is rare.
No one sign is typical of cretinism or insufficient thyroid, but a combination is well-nigh unmistakable. The child has physical and mental torpor. The circulation of the blood is poor. In fact, all the activities of the body are under par, including the muscle tone, sweating, and the activity of the bowel. The growth, including bones and teeth, hair and brain, is stunted. The skin is thickened and coarse and fluid accumulates under the skin. The cretin is sluggish and shows little interest in what goes on around him.
The child with deficient action of the thyroid responds rapidly to treatment with thyroid extract. Almost immediately there is improvement in color and warmth of the skin. Within a few weeks there is loss of weight as the body gets rid of the extra fluid. Almost immediately, growth begins again. Because of this prompt benefit there may be a tendency to give more and more thyroid, and this will have bad results as shown in heightened excitability, nervousness and a rise in the blood pressure.
The earlier a diagnosis can be made and the sooner treatment can be begun the better. Sometimes the damage to the brain by just a few months deficiency may be so severe that it is difficult if not impossible to overcome. Such children may become irritable and unmanageable after treatment, and the doctor must determine the amount of thyroid necessary to keep the child under control.
Excess Action Of The Thyroid
Although the condition called hyperthyroidism, which is due to excessive action of the thyroid gland, was first observed around 1830, a really complete understanding of the condition did not develop until 1890. Excessive action of the thyroid may occur at any age. The condition is much more frequent in women than in men. In areas in which goiter is infrequent, women may have excessive action of the thyroid gland in a proportion of four women to one man.
The exact cause of excessive action of the thyroid gland is not known, but the most frequently accepted view at this time is that the body responds to stress, either emotional, physical, or infectious, by excessive action of the pituitary gland which in turn over stimulates the thyroid gland. If this condition goes on, such symptoms may develop as bulging of the eyes, which is a part of exophthalmic goiter; and there may be enlargement of the thyroid gland, although there are cases in which the thyroid gland is enlarged without other symptoms. The person who is over stimulated by thyroid is nervous, irritable and emotionally unstable.
Since excessive action of the thyroid is due to secretion of too much hormone or glandular substance, treatment of the condition includes a number of different procedures. The certain method is removal of a portion of the thyroid gland by surgery, with or without the use of such drugs as propylthiouracil which diminish thyroid activity.
Radioiodine, which is a radioactive form of this substance, is now used to treat excessive action of the thyroid gland. In some cases excessive action of the thyroid may be so great that serious symptoms develop, including fever, an exceedingly rapid beating of the heart and even prostration.
The bulging in the throat that is due to enlargement of the thyroid gland was apparently recognized by the Chinese at least as early as 1500 B.C. Such is indicated by drawings and other historical records. Indeed, the people used to overcome the condition in the Middle Ages by eating burnt sponge and seaweed which are rich in iodine. Not until 1916, however, was the evidence accumulated that made it certain that small doses of iodine taken frequently by the patient living in areas in which there are small amounts of iodine in the soil and in the water will prevent simple goiter.
Certain substances have been recognized as having the power to stimulate goiter, but goiter caused by these substances-like thiocyanates or cabbage, which cause a lessening of thyroid hormone-is infrequent.
The chief symptoms of goiter are, of course, the enlargement and bulging in the throat due to the large size of the gland. There are cases, however, in which the enlargement becomes so great that it may even interfere with breathing or injure the voice by pressure on the nerves that go to the larynx. The prevention of such enlargement of the gland by the taking of small doses of iodine regularly during the period of childhood and adolescence is now well established. Iodized salt is now commonly used, so that the iodine is taken regularly in this manner. In cases of severe enlargement of the gland obviously removal by surgery is desirable.
Behind and near to the thyroid gland are other glands which are known as parathyroid glands, their chief function being control of the use of calcium and phosphorus by the body. Apparently this gland responds with secretion of its hormone when the amounts of calcium and phosphorus in the serum of the blood become insufficient. However, extracts of the parathyroid gland have been prepared and are used in cases where people apparently suffer from a lack of parathyroid hormone. The lack of this hormone is made evident by such symptoms as tremors of the body, called “tetany,” which occurs also with insufficiency of calcium. The tetany or tremors, which are like muscle spasms or cramps, are due to extra excitability of the nerves controlling the muscles.
Obviously the condition may be controlled by giving extra calcium directly into the blood or by taking large amounts of calcium by mouth. The condition may also be controlled by direct injection of the parathyroid hormone. Calcium is also controllable through the use of vitamin D or of a substance like vitamin D called dihydrotachysterol.
The action of this substance is more like the action of the parathyroid hormone than is vitamin D itself. In the treatment of this condition, the diet should be one which contains much calcium and relatively little phosphorus. The foods which are rich in calcium are milk and cheese products and the leafy green vegetables. Milk also, however, includes phosphorus, as does egg yolk, cauliflower and molasses.
As might be expected, excessive action of the parathyroid glands results in changes of the bones of the body, because the bones are largely made up of calcium. Since the parathyroid glands so definitely control the use of calcium by the body, some have thought that kidney stones might be due to some action of the parathyroid glands. This has not, however, been established with certainty. Cases of excessive action of the parathyroid gland can occur without any evident changes in the bones and, in fact, the condition may be more frequent than is now suspected. There may be excessive growth of the tissues of the parathyroid glands which can result in excessive activity.
When large amounts of extra calcium are found in the blood and with that muscular weakness, loss of appetite, and pain in the bones, and, not infrequently, excessive elimination of fluid through the kidneys, the physician suspects excessive action of the parathyroid glands.
Since vitamin D has become available as a concentrate, and since people have been taking exceedingly large doses of vitamin D to treat a variety of conditions, difficulty has occurred in recognizing the difference between excessive vitamin D in the body and excessive action of the parathyroid glands. In every case of hyperparathyroidism the possibility of surgical removal of excess tissue of the parathyroids must be considered as primary in the treatment.