Surgeon to St. Mary’s Hospital and to the Methodist Episcopal Hospital,
Brooklyn.
CONTRIBUTIONS TO THE STUDY OF MYXŒDEMA FOLLOWING TOTAL OR PARTIAL
EXTIRPATION OF THE THYROID BODY.
J. L. Reverdin (Congrès Francais de Chirurgie, 2 session, Paris, 1886.)
This disease, following frequently in the after-history of cases of
extirpation of the thyroid body, and called by Kocher, of Berne,
cachexia stumpriva, was first described by Reverdin, and by him called
“operative myxœdema.” His description of this disease coincides in
general with the views now generally held, although we find some not
unimportant deviations from Kocher’s conclusions; for instance, the
latter observed the disease twenty-four times following thirty-four
operations, it appearing to attack by preference those who had not
attained their full development. On the other hand, R., basing his
experience upon copious statistics, believes the disease is
comparatively rare, following upon operations of the thyroid in only
twenty-seven per cent. of cases. In his experience, it likewise
preferably attacks children and young persons, but that it occasionally
fails to occur after complete thyrotomy. Further, R. has observed a
milder form of the disease, differing essentially from the graver type
of the affection, which latter invariably tends progressively to a fatal
termination. In the milder form, the disease is described as oscillating
between relapses and improvement, lasting for years, cure sometimes
resulting. Several cases are detailed supporting these observations. In
two of these, it was supposed that the thyroid had been extirpated in
toto, but it was subsequently discovered that a small portion of the
gland had remained. Three cases are worthy of especial note. In these,
after partial extirpation, in one the right lobe, and in two the left
having been removed, an imperfect form of the disease made its
appearance after several months. The characteristic signs, such as
swelling of the face and limbs and hesitancy of speech and of muscular
movements were absent; while the other symptoms, such as general
weakness, pains in the limbs, chest, and head, greater or less loss of
memory, chilly sensations, reminded one distinctly of the more complete
form of the disease. In all these cases slow improvement followed.
Another case is worthy of notice from the fact that, two months after
the operation, the remaining lobe had so atrophied as to be scarcely
distinguishable. Cases of this atrophy following partial extirpation
have been observed both in Germany and in England.