Myxedema is a chronic disease due to loss of thyroid function, and
characterized by markedly decreased metabolism, trophic disturbances
of the skin and subcutaneous tissues, and a cessation of mental
development corresponding to the time of the injury of the thyroid.
McCarrison restricts the term “cretinism” to those cases where there
is congenital thyroid deficiency. “After the first year of life, when
ossification has proceeded to the extent of closure of the fontanelles,
the case is only distinguishable from one of cretinism by this fact.”
In the =child=, all the functions are depressed, there is a low
temperature, the bones do not develop, and the child may become stout.
The mental development is retarded, and also the sex organs.
In the =adult= cases there is the same depressed metabolism. The skin
is sallow, dry, and increased in thickness. The tongue is enlarged,
the lips thick, and the feet and hands considerably changed in size.
The nails may be thickened, and the hair falls out. The abdomen is
apt to be pendulous. Heavy pads occur below the clavicles and on the
chest, neck, abdomen, and sexual organs. Usually the thyroid cannot be
palpated. In a few, the gland may be goitrous.
The =mental= faculties are sluggish. The speech is slow, and the voice
more or less changed. Physical exertion is an effort, and the patient
may have some difficulty in walking. And there is anemia, loss of
appetite, and poor digestion. The number and character of symptoms are
innumerable, depending upon the extent of thyroid insufficiency, and
often upon predisposing and associated disorders. But the essential
symptoms are those pertaining to the skin, and the mental apathy. In
children the retarded physical and mental growth is the outstanding
condition. Development of the disorder is slow.
=Etiology.=—Lesions of the thyroid innervation may cause a lessened
function of the gland, for correction of the lesions has been followed
by markedly definite improvement in a number of cases. The disorder
has followed operation on the gland. In other cases some form of
infection, primary or secondary, is probably the cause of the injury
and subsequent atrophy. In some instances there is evidently a family
tendency. It occurs more frequently in women, and in cold than in hot
climates. The menopause seems to be a predisposing factor. Overwork,
anxiety, poor nutrition, and conditions that lower tissue resistance,
are among the etiological considerations.
In well marked cases the =diagnosis= is easy. In others the disease
may be mistaken for nephritis or jaundice. X-ray examination of the
ossification centers is of decided value. The =prognosis=, in untreated
cases, is considered hopeless, the duration being from four to seven
years. The treatment with thyroid extract, or alpha-iodine, has
resulted in marked improvement, though in severe cases it must be kept
up continuously in order to supply the deficiency.
=Treatment.=—There have been several well marked cases that have
responded to the osteopathic treatment. Adjustment of the lesions
affecting the gland, and attention to the general health have been
the methods administered. The response in a number of children has
been most notable. In fact, to such an extent that all faculties and
functions were completely recovered. Even in cases where thyroid
extract had been administered with comparatively little results, the
adjustment of the upper dorsal and cervical lesions, with attention
to the diet, elimination, and general hygiene, was followed by
normalization.
That the thyroid function when deranged, hyperthyroidism,
hypothyroidism, or otherwise, can often be recovered through
osteopathic treatment, adds a very important therapeutic measure in
the treatment of this gland. But in view of the brilliant results
secured in hypothyroidism, through the administration of the thyroid
extract, one should not hesitate to use it if improvement is not
otherwise forthcoming. Nevertheless, the very important point remains
that thyroid extract is only supplying a necessary substance, however
essential, to the bodily metabolism, and does not strike at the
essential etiology of the disorder.