Were the title of this paper more expansive it might embrace the larger subject of goitre of thyroid enlargements, which is described by classical writers as:.
a swelling in the front of the neck, internal to and under the sternomastoid muscles and internal to the carotid vessels, which, if the swelling is large enough, are pushed outward. The gland in connected intimately with the larynx so that it rises and falls with the larynx and trachea during deglutition.
Hyperthyroidism is limited, however, to certain aspects of overactivity of the thyroid gland.
Physiologically the thyroid is known to enlarge during menstruation in some subjects and in pregnancy.
There are several types of goitre, chief among them being: colloid goitre, which affects, the whole gland; cystic goitre, which covers various types of cysts in the glands; adenomatous goitre, which may be unilateral, and may give rise, under certain conditions, to suspicions of malignancy; fibrous or ligneous goitre, which is a form of chronic inflammatory enlargement; carcinoma, which, fortunately, is seldom encountered, but when it does may occur in both sexes, though rarely seen prior to the age of forty.
Exophthalmic goitre proper (Graves disease, or von Basedows disease) is most common in women and girls, but seldom seen before puberty or after middle life, hence would seem to bear some relationship to the reproductive function.
It is marked be exophthalmos, tachycardia with palpitation, enlargement of the thyroid, which may be marked by pulsation, tremors of the bands, tongue and general nervous excitability, breathlessness on exertion the characteristic von Graefes sign, Stellwags or Dalrymples sign, pigmentation of the skin, which may simulate Addisons disease to some extent.
Graves disease is sometimes classified as (1) true exophthalmic; (2) toxic goitre, and may be due to pyogenic infection, or pyemic; the thyroid may also be enlarged from tuberculous or gummatous deposits; and it has been known to enlarge during typhoid fever, acute rheumatism, malaria, variola, cholera, and secondary syphilis.
Hydatid cysts have also been noted; and the thyroid has been known to enlarge as the result of mental strain, fear or fright, and in debilitating infections such as trench fever. This briefly is goitre as designated by no less an authority than George E. Gork, in herbert Frenchs admirable Index of Differential Diagnosis.
As our subject is limited to the problem of hyperthyroidism, we must limit our study to that variety of thyroid disturbance which is characterized by the clinical signs enumerated above, and said to be etiologically related to thyroid over-activity, or hyperfunction, with excess of thyroid secretion, which is sometimes spoken of as “an abnormal condition brought about by an excessive or depraved functional activity of the thyroid gland.” This predisposes the hyperproduction of thyroid substance or the secretion of thryoidin or thyroiodin.
In order that this paper may not become too extended, we shall not discuss the remedies indicated homoeopathically in detail; we shall merely call the attention of the members of the I.H.A. to two admirable papers published in the June number of the Homoeopathic Recorder, on by Dr. H.A. Roberts, on Homoeopathic Therapeutics in the Field of Endocrinology; the other, by Dr. C.P. Bryant, the President of this Association, on Homoeopathic Remedies as a Preventive to Specific Surgical Conditions and Their Use After.
Kent lists fifty-nine remedies in Goitre, in his Repertory, chief among them being: Calcarea, Iodine and Spongia, showing that the difficulty is chiefly related to calcium or iodine deficiency or the inability of the organism to assimilate these substances which are normally present or should be in the daily food to furnish the thyroid gland sufficient for its metabolic needs.
Dr. Bryant lists Amyl, nit., Kali iod., Lycopus, Ferrum, Hypericum, Baryta iod., Bromine, Duboisin, Natrum mur., Iodine and Belladonna, as the chief remedies he has found useful in this condition. The indications for these remedies and those which may found serviceable in endocrinology are so well covered by Dr. Bryant that I shall not take the time to reiterate their symptomatology.
The Pacific Coast journal of Homoeopathy for January, 1939, contains a paper by Dr. John S. Hunt of Santa Monica, California, on the use of Calphiomin, formerly called “Par Kelp”, in the unbuilding of the body following fractures, also in the prevention of tooth decay, and in gland functioning, which would naturally suggest its experimental use in goitre. Par Kelp is pure kelp which is obtained from the sea floor by a special machine made for its mowing. And it is well known that sea lettuce and various other forms of marine growth enter largely into the daily diet of the Japanese race to prevent thyroid and other glandular deficiency.
In this connection, I have recommended for a long time the use of Iceland or Irish moss, served in the form of blanc mange, in cases of thyroid deficiency; and it has been my experience that the best clinical results have been obtained from lime and iodine, in whatever proportion is called forth by the indications.
Some years ago, while working at the Massachusetts Homoeopathic Hospital (now the Massachusetts Memorial Hospital) Dr. Conrad Wesselhoeft was greatly interested in the use of Belladonna as a remedy in the nervous phenomena of hyperthyroidism; and the tremors, nervousness, pulsating vessels, and some other symptoms would certainly suggest it as one of the remedies for this condition, and this has been shown by Dr. Bryant to be the case. I have never seen the remedy do much more than palliative work in cases where it was given. Its complement, Calcarea carbonica, would seem to me to be much more fundamental when indicated in even the varied forms of thyrotoxicosis.
The late Frank W. Patch had at one time a volume devoted entirely to the Non-Surgical Treatment of Goitre, in which the author claimed to benefit the majority of these cases by psycho- therapeutic measures designed to quite the nervous worry and apprehension of such cases. Once the patients fear of goitre and nits serious results, together with the dread of operation, were removed, the management of such cases became much easier, to say the least; and undoubtedly this is a definite fact.
I once assisted Dr. H.E. Maynard in a Caesarean section in a small goitrous woman, who went through her operation and made an uneventful recovery, with a subsequent return of the pulse rate to normal, thus bearing out the statement above quoted regarding the incidence of goitre during pregnancy. Surgery in such cases is necessarily a hazardous procedure.
One case I recall as exemplifying the sequential cycle of glandular involvement was that of a well developed girl, though rather tall for her age, who had first of all an operation for the removal of adenoids and tonsils; next in order came the removal of the appendix; then a toxic goitre was extirpated at the Lahey Clinic in Boston; and to add to this line of devastation only a few years ago the uterus was removed by a Los Angeles surgeon; and now there is an apparent cessation of glandular pathology, but the patient has some undoubted myocardial deficiency, and has to take frequent periods of rest to avoid very grave fatigue.
I have had but little to do in the actual treatment of this case, although I did strive vainly to prevent the necessity of her appendectomy, but as some of our astute prescribers have pointed out, the incidence of appendicular involvement follows too rapidly and too ominously upon the heels of adenoid and tonsil removal to trust to remedial measures alone; in my experience it is this type of appendix that all too readily takes on the gangrenous and often fatal form.
The again, surgery is not always the bright and brilliant success that its advocates would proclaim it to be. In this connection, may I cite a case that recently came to my attention through its recital by one of Dr. R.E.S. Hayes; patients, whom it was my bounden duty to place in the hands of a competent surgeon two years ago, to evacuate a dangerous abscess of the appendix, and whose recovery was completed with the healing of a faecal fistula through the action of Dr. Hayes appropriately prescribed remedies.
The case in point was the fiancee of Dr. Hayes patient, who having had an operation for goitre was left with permanent injury to the vocal cords, making phonation difficult, if not quite impossible. A tube was placed in the larynx, and finally this became very uncomfortable and impossible for the patient, the only recourse in order to give partial restoration of speech was a slitting of the vocal cords. The patient can now speak in a voice but slightly above a whisper. Thus it goes- sometimes-in surgery.
One or two striking cases have come to my attention, with respect to the action of remedies. One of these was the rapid action of Iodine CM., in a patient to whom Dr. M.I. Boger- Shattuck had previously given this remedy in the same potency. Another case seen while in Ports-mouth, New Hampshire, a year ago, well exemplifying the action of Bromine in the 1M. potency, was that of a young married woman in whom a very rapid reduction in the size of the goitre took place, which had been very resistant to previous treatment and was causing marked pressure symptoms.
Iodine in high potencies has several times before done magnificent work for me in the treatment of enlargement of the thyroid gland. I have also found that small doses of Thyroidin, in Boericke & Tafels 3x. or 6x., or even the 30x., has given excellent results in the tachycardia so prominent and annoying in goitre.
While these few cases are suggestive only, I feel justified in the belief that we have in our list of remedies the most valuable aids in the treatment of goitre known to medical science. Nor should we omit mention of the striking results that can sometimes be obtained from thyroid feeding, so called, in cases of the hypothyroid form, though my experience in this field has been but limited.
I recall a striking case reported at a meeting of the Massachusetts Homoeopathical Medical Society many years ago by no less excellent a Hahnemannian than Dr. Maurice Worcester Turner, in which comparatively small doses of the gland brought about apparently striking results. No doubt Dr. Turner supplemented this organotherapy with appropriately indicated potencies.
Then again, it was but two or three years ago that my brother, Dr. G.F. Woodbury, showed me a case of hypothyroidism, that had erroneously been diagnosed as pernicious anaemia, that disappeared miraculously, as it were, by the use of substantial doses of the extract of the whole gland.
I regret the paucity of real therapeutic pabulum in this paper, but the few suggestions here given may lead others to recall experiences of vaster clinical value in goitre and its treatment.
For an excellent survey of goitre indications, the resume by Dr. Margaret Tyler, in the July number of Homoeopathy, my very profitably be consulted. The paper is entitled, Some of the Drugs Useful in Goitre; and the remedies with their comprehensive indications are: Iodium, Spongia, Sepia, Bromium, Lachesis, Apis, Carboneum sulph., Sulphur, Calcarea, Natrum mur., Kali iod., Tuberculinum, Drosera, Aurum, Aurum iod., Lycopodium, Conium, Natrum carb., Carbo animalis, Silica, Magnesia carb., Zincum, Lapis albus, Crotalus cascavella, Mercurius cyanatus, Lueticum. There is also an appended note from the British Medical Journal, January 30, 1937, listing calcium, boron, silica, tellurium, organic acids, aminos and cyanides, as among the chemical substances capable of causing goitre in animals. BOSTON, MASS.