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By David G. Ferriman

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1. — a. —Often raised in hypothyroidism. Changes in hyperthyroidism not diagnostic. b. —Unreliable in nervous subjects. Performance of the test under sedation will increase its reliability b u t presents technical difficulties. BMR is also raised in cardiac failure, fever, blood dyscrasias, and other conditions. The test is being replaced by other methods. c. —Tendon reflexes are brisk in hyperthyroidism, and show a characteristic slow relaxation in hypothyroidism. This can be tested by measuring the duration of relaxation of the ankle-jerk, in milliseconds.

Myasthenia gravis sometimes associated. 2. — a. —Normally a single nodule is palpable in the thyroid gland. Occasionally more than one nodule is present. b. —Signs and symptoms essentially the same as in the LATS-produced syndrome. c. E Y E SIGNS ARE MINIMAL OR ABSENT. — 1. —Various arrhythmias, notably atrial fibrillation and congestive cardiac failure. 2. —See section on malignant exophthalmos (p. 40). 3. — a. —A generalized possibly severe myopathy thought to be due to direct metabolic effect of excess thyroxine on muscles.

5. Intravenous hydrocortisone—initial dose 100 mg. 8-hourly. 6. Antibiotics as prophylaxis against pneumonia. —Poor, even with skilled management. —Two forms of hyperthyroidism can be distinguished :— 1. —Many, if not all, cases of toxic diffuse goitre are thought to be due to the presence in serum of an abnormal substance known as long-acting thyroid stimulator (LATS). This is believed to be an auto-immune antibody produced by the reticulo-endothelial system. It is found in the serum y-globulin fraction.

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