Goitre.

Synonym.—Bronchocele.

Definition.—This is a hypertrophy of a part or the whole of the thyroid gland, and occurs sporadically or endemically.

Etiology.—The exciting cause is unknown. Goitre occurs sporadically or endemically, and Sievere speaks of an epidemic occurring at Serdobal, Finland, where a teacher and fifteen children were suddenly attacked. Locality seems to favor the disease, for while it occurs in all countries, in certain districts, which have many points of resemblance, it occurs in far greater numbers, and is thus said to be endemic in such localities. Mountainous districts seem to favor its propagation. Thus it is common in Switzerland and. Italy, in the Himalayas, and in the hilly districts of China.

In Ontario, Canada, many cases are seen. It is found more frequently in women than men, especially in this country, and is accounted for on the grounds that women drink more water than men, while in India both sexes drink the same amount of water, and are equally affected with goitre.

The disease usually appears shortly after puberty, especially in girls, where there is some derangement in the menstrual flow.

There seems to be some constituent of the water-supply in certain sections that favor the formation of goitre, though what that constituent is, no one has been able to determine. A change in the water-supply, where goitre has prevailed, has led to a disappearance of the disease

Heredity.—In some families heredity seems to play an important role.

Pathology.—The gland undergoes various degenerative changes, and has been divided by Murray into four varieties: (a) Hypertrophic or parenchymatous goitre; (b) Adenoma of the thyroid gland; (c) Fibrous goitre; (d) Cystic goitre. Besides these types there may be various combinations.

In parenchymatous or hypertrophic goitre there is a hyperplasia of all the original tissue-elements. It may be confined to one lobe or involve the whole gland. "Adenoma of the thyroid occurs as an encapsuled growth, there being one or more nodules in one or both glands; the structure resembles that of the gland itself.

"In a fibrous goitre we have, in addition to overgrowth of the glandular substance, a large increase in the fibrous tissue, which may occur as bands running through the substance of the goitre or as fibrous nodules.

"Cystic goitre occurs, either as a result of expansion and coalescence of the follicles of an already enlarged gland, or as the result of softening of portions of the goitrous tissue; such goitres often contain a large amount of fibrous tissue and are distinguished as fibrocystic goitres." (Murray, "Twentieth-Century Practice.")

Symptoms.—As a rule the first evidence of goitre is a visible enlargement of the neck, and though, on swallowing, a pronounced tumor mass is seen to move upward, the patient experiences no pain. The growth develops slowly, is not attached to skin nor deeper tissues as a rule, and may be readily moved. They vary as to size, from one that is barely perceptible to one of enormous proportion, interfering with the movements of the head. When deep seated and it presses upon the trachea and esophagus, respiration and deglutition are rendered difficult, and dysphagia occurs more frequently than dyspnea. Cerebral disturbances, with convulsions, have been reported, though such symptoms must be exceedingly rare.

The general health is not affected, unless inflammation and suppuration attack the goitre, in which case there will be more or less systemic disturbance.

Diagnosis.—Goitre is easily diagnosed from other cervical affections. The constant location, the absence of pain, and the vertical movement during deglutition, can hardly be mistaken for other affections.

Prognosis.—This is favorable so far as the life and general health is concerned, but too much must not be expected from medication, except in recent cases. Where fibroid changes have taken place, thyroidectomy promises the only relief.

Phytolacca.—I know of no one remedy that promises more in the cure of goitre than phytolacca, when given in tangible doses. Two drams of the tincture to water four ounces, and a teaspoonful every four hours. Iris versicolor may be used in alternation or combination with the above. Galvanism has been successful in my hands in a few cases.

Colorless iodin should be thoroughly applied night and morning. Thyroid feeding has been highly extolled, and may be given a thorough trial.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.