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Most of the larger and many of the smaller surgical, medical and psychiatric clinics of the world have followed the study of the clinical and pathologic relationships of the various thyroid disorders with intense interest. Among these disorders, the constitutional state termed hyperthyroidism has probably been most controversial because of its complicated nature and protean manifestations.
According to Plummer (1) “Hyperthyroidism is the physiologic, status of an individual otherwise normal when the thyroxin in the tissues is sufficient to hold the basal metabolism above normal” and “thyrotoxicosis” is the term used to designate the constitutional state associated with goitre. At present there seems to be no question but that hyperfunction of the thyroid gland is the essential factor in the syndrome and that its secretion, thyroxin, when in excess as in exophthalmic goitre is productive of the well known phenomena; but our conceptions as to the pathogenesis, and as to what factors enter into the predispositions of certain individuals in the development of the disease remain rudimentary and indefinite, notwithstanding the attempts made to utilize the principles of bacteriology, general metabolism, endocrine imbalance, and neurogenic activity to explain these fundamentals.
The mental symptoms associated with true exophthalmic goitre and other forms of hyperthyroidism, long since known and described but only recently emphasized, are nearly if not quite as characteristic of the condition as are the more objective physical signs and there are a number of instances on record where a sudden intense emotional experience has initiated attacks of acute hyperthyroidism associated with exophthalmic goitre; however in these instances the profound emotion can be only the exciting cause while the principal basic factors lie elsewhere in the experience of the individual.
Considering the objective physical symptoms of hyperthyroidism, it must mean something more than a curious coincide