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R a d i u m 9
I he subjective symptoms are many, and comprise great nervousness
and trembling, Bushings of head and face, palpitation, spasmodic dyspnoea,
pruritus, thirst, vomiting and diarrhoea, great mental instability.
forget fulness and depression.
The disease often proves wry obstinate and distressing, and medical
treatment, though of the greatest value in the relief of symptoms, has
but little effect on the duration of the disease. In suitable and selected
cases the operation of partial thyroidectomy is undoubtedly the procedure
offering the best prospects of permanent relief or cure, but many
patients emphatically refuse operation, and radium treatment is advised.
Prolonged irradiation with the gamma rays often proves most beneficial.
especially if there is no vomiting or diarrhoea, and the patient is not
emaciated. Klat applicators containing from 70 to too mgrs. of radium
element screened with 2 mm. of lead are employed, and a total exposure
of from twenty to thirty hours' duration given. The treatment is
sometimes followed by a definite exacerbation of all the symptoms, and
it seems fair to attribute this to the congestion attendant upon the reaction,
causing an increased outflow of the thyroid secretion into the blood
stream. Such exacerbation, however, proves transient, and is usually
followed by a gradual but steady and definite improvement in the patient's
symptoms and general condition, and this may probably, almost
certainly, be ascribed lo the action of the rays producing an arrest of the
vitality and retardation in the development of actively proliferating cells.
thus restoring the output of the cellular secretion more nearly to normal
limits. With this there is also associated a fibrosis of the connective
tissue of the gland, causing the organ to become firmer and smaller. The
patient should be seen at intervals of three months, and the treatment
repeated, if necessary, with such modification as may seem advisable.
(3) Malignant Goitre.—Malignant disease of the thyroid gland
may be either carcinomatous or sarcomatous. In the absence of the
information that may be obtained from a biopsy, the clinical differentiation
is often extremely difficult, though as a general rule sarcoma is apt
to attack one lobe only and to grow with extreme rapidity; carcinoma
is more likely to affect both lobes and to progress more slowly.
The disease is one of late adult life, cases occurring before the age
of fortv are extremely rare. Not infrequently, on eliciting the history
of a case of malignant disease of the thyroid it is found that the patient
bad an innocent goitre for many years. In the early stages of the disease,
whether carcinomatous or sarcomatous, the growth is enclosed
within the capsule of the gland, but in a very short time it perforates
it. and invades the adjacent structures, surrounding- the carotid artery.
involving the trachea and pharynx and paralyzing the vocal cord. Fixation
of the growth occurs to larynx, trachea, sternum, clavicle, etc. It is
important to note that a growth, when firmly fixed to the trachea only.
will move with it on deglutition, but cannot be moved on it.
Tlie majority of cases presenting themselves at the Radium Institute
for treatment are in a very advanced state, there being a large, hard.
firmly fixed growth affecting one or both lobes, the surface being bossy
or irregular. Dysphagia, dyspnoea, hoarseness, neuralgia pain in head
and neck, and paralysis of the sympathetic may one or all be present.
In these advanced and inoperable cases radium treatment should most
certainly be adopted. It will often arrest the progress of the disease
in a most striking fashion, causing a great reduction in the size of the
growth and affording much relief to the symptoms.