Thyreoid Therapy. 
BY 
JAMES B. HERRICK, M.D. 
REPRINTED FROM 
MEDICINE. 
CiEO. S. DAVIS, Publisher. 
August, 1896. THYREOID THERAPY.1 
JAMES B. HERRICK, M.D., Chicago. 
During many decades no therapeutic advance has been made at 
all comparable in importance to the discovery of the antitoxin of 
diphtheria, and the use of the thyreoid gland in the treatment of 
myxedema. The antitoxin opens up the wide field of serum- 
therapy, in which many workers already make more or less favor- 
able reports concerning the serum treatment of other infectious 
diseases, such as tetanus, typhoid, pneumonia, scarlatina, septi- 
cemia, tuberculosis; and the thyreoid opens up the field of organ- 
therapy, with experiments and observations rapidly multiplying as 
to the therapeutic value of extracts of the kidney, adrenals, testicle, 
brain, and other organs. Omitting from consideration all preven- 
tive measures, such as vaccination, boiling and filtering of water, 
etc., it may be said that we have four remedial agents that are truly 
curative or specific—potassium iodide, quinine, diphtheria antitoxin, 
thyreoid extract. To the latter I wish to direct your attention for a 
few moments. 
The story of the discovery of the virtues of the thyreoid gland 
in the treatment of myxedema is as interesting as a romance. You 
are undoubtedly familiar with it, so that I need merely call to your 
minds some of the more important facts. You remember that Gull 
in 1873 made a clinical demonstration “on a cretinoid state super- 
vening in adult life in women,” Ord in 1877 reported two cases, 
with an autopsy where atrophy of the thyreoid gland, and mucin in 
the subcutaneous tissue were striking post-mortem findings. Char- 
cot and his pupils, and Hadden in England, made still further 
clinical observations, and a little later the surgeons Reverdin and 
Kocher declared the changes in many of their patients from whom 
they had removed thyreoids to be the same as in Ord’s myxedema. 
Independently, too, the physiologists Schiff and Horsley—the one 
in Switzerland, the other in England—showed that the removal of 
the thyreoid in the lower animals—the dog and the monkey—was 
followed by cretinoid symptoms and death. By the implantation of 
a thyreoid into the abdomen, however, life was prolonged. The 
conclusion, therefore, was inevitable, that the thyreoid gland had a 
function necessary to the maintenance of health or even life. In 
1888 the report of the Committee of the Eondon Clinical Society 
was made, declaring that cretinism, idiopathic myxedema and, oper- 
1 Read at the meeting of the Illinois State Medical Society, Ottawa, May 19, 1896. 2 
THYREOID THERAPY 
ative myxedema were but different types of one and the same dis- 
ease, depending upon an anatomical or physiological (functional) 
absence of the thyreoid gland. 
Surgeons and experimenters now noted the good effect of leav- 
ing a portion of the gland when it was to be removed, and also the 
benefit from implanting thyreoids, as of sheep, into the abdomens of 
human beings suffering from myxedema (Kocher, Horsley, Bircher, 
Eannelongue). Vassale injected thyreoid juice; and Murray, in 
England, reported in 1891 the successful subcutaneous employment 
of a glycerin extract of the thyreoid gland. The next year fresh 
glands were fed by Horwitz in Copenhagen, and Mackenzie and Fox 
in Eondon, and a little later the pharmacists had prepared the dried 
powdered glands or dried extracts in various forms. 
It is of interest to note that we owe this great discovery in 
medicine to no one man, to no one nation. Clinicians, surgeons, 
experimental physiologists, pharmacists, have each worked, often 
independently, in their own lines, until fact upon fact has been 
accumulated, all proving that myxedema, under whatever name it 
goes, is athyreoidea, and that the disease is curable by supplying 
through the thyreoid glands of lower animals the chemical sub- 
stance that is lacking. 
Theory of Action.—The older theories as to the purely nervous 
origin of myxedema are at present discarded. Since Schiff and 
Horsley experimentally, and many observers clinically, have proven 
that the thyreoid gland has a function, other theories have been 
advanced. Schaefer1 states the two main theories clearly when he 
says the first is the auto-intoxication theory—the thyreoid a gland 
having for its function the destruction of natural toxins which 
without this antidotal action lead to the condition we call myx- 
edema; the second the internal secretion theory, the thyreoid a 
secreting gland, its secretion taken up by the lymph - vessels 
and necessary for the proper metabolism of the body, especially 
for nervous and connective tissue. According to either one of 
these theories the administration of thyreoid extract merely sup- 
plies the lacking secretion—supplies, in other words, some chemi- 
cal substance that is necessary to health, or even life, but which the 
diseased or absent gland fails to supply. To quote Kwald: “The 
secretion of the gland acts as an antitoxin against certain toxins 
that appear as the by-products of tissue change. ’ ’2 
Just what this substance is, has not been accurately known. 
i British Medical Journal, August 10, 1895. 
2 Centralblatt fur Innere Med., No. 17, 1896. THYREOID THERAPY 
3 
But Baumann has recently eliminated an organic iodine compound 
from the thyreoids of sheep, to which he gives the name thyro- 
iodine, and investigations are going on to try to prove whether this 
is the effective chemical agent in thyreoid therapy. The results thus 
far are in favor of this view.1 If it is, and if it can be manufactured 
synthetically in the laboratory, and if its dose can be proven experi- 
mentally, we shall have a most valuable therapeutic acquisition. 
Baumann hopes to be able to explain why glycerin-and-water ex- 
tracts of the gland are therapeutically active, while thyro-iodine is 
insoluble in water. There may be other compounds equally as effi- 
cacious as thyro-iodine. 
It may be added that some of the untoward effects of the 
thyreoid extract are believed by some to be due to impure or 
contaminated remedies. Fresh glands produce less of unpleasant 
thyreoidism than older ones that have undergone decomposition 
with the formation of undesirable chemical compounds. With a 
synthetic thyro-iodine any undesirable by-effects would be avoided.2 
Method of Administering.—The cruder methods of feeding fresh 
or cooked thyreoids or of injecting subcutaneously a glycerin ex- 
tract, have given place to the more accurate, pleasanter and easier 
methods of employing the dried powdered glands or the tablets con- 
taining the essential principles. Several firms now furnish good 
and reliable articles. 
Dose.—For an adult, from three to fifteen grains of the pow- 
dered gland a day. Burroughs & Wellcome prepare a compressed 
tablet of dry thyreoid gland. One tablet equals one sheep’s gland. 
The dose is from one-half to four tablets daily. Kraus has given as 
high as five or six a day,3 Parke, Davis & Co. have a thyreoidiu 
tablet that I have found reliable in a case of cretinism, the largest 
dose in one da}’ not exceeding two tablets. They also make in 
tablet and powder form a preparation they call thyreoids, claiming 
for it all the virtues of the powdered glands. 
Effects on Healthy Individuals.—The effects in health are not 
constant. Many report no effect. Commonly, however, large doses 
produce loss in weight. Diuresis, rapid heart’s action, headache 
and insomnia are reported {vide Kraus). 
2 Roos, Treupel and Ewald believe the thyro-iodine contains the specific principle or 
principles of the thyreoid gland, and that it can be substituted, therefore, for the fresh 
glands, the extracts, and the dried preparations of the same. One gramme of thyro-iodine 
contains three-tenths of a milligramme of iodine, and corresponds, so far as amount of 
iodine is concerned, to one gramme of sheep’s thyreoid. 
1 Cf. Uwald, Roos, Treupel. 
Ewald on the “Therapeutic Use of Thyreoid Gland Preparations.” Report of the 
Proceedings of the Fourteenth Congress of Internal Medicine at Wiesbaden, April, 1896. 
Centralblatt fur Innere Med., April 25, 1896. 
3 Therapeutische Wochenschrift, Jan. 26, 1896. 4 
THYREOID THERAPY 
THE THERAPY OF THE THYREOID GRAND. 
i. hi myxedema. It can be put down as a settled fact that 
thyreoid extract is curative in myxedema. It would be useless to 
cite the numerous reliable reports of isolated cases and of series of 
cases that have thus far been published. British journals, particu- 
larly, seldom let a week pass without reciting some new case, often 
with cuts showing the ‘ ‘ before and after taking ’ ’ stages, in which 
thyreoid extract has wrought the almost miraculous change in some 
woman’s physical and mental condition, or has transformed some 
stunted, stupid, pigmy-like imbecile—“toad-like caricature of 
humanity,” Osier calls it—into a bright, laughing, growing, wide- 
awake child. 
When the extract is fed to a myxedematous individual in full 
doses, most remarkable effects are noted. To these phenomena the 
term “ thyreoidism ” has been given. One is reminded in this con- 
nection of the somewhat analogous effects of our other specifics— 
cinchonism and iodism. 
There is a rapid loss of weight; the fatty masses above the 
clavicles disappear; the mucin in the subcutaneous tissues vanishes. 
Not infrequently a sharp rise of temperature occurs in striking con- 
trast to the previously existing subnormal temperature. The pulse 
rate increases. There are sweats; the skin itches; at times desqua- 
mation takes place. There may be diarrhea and vomiting. Pains 
in the joints, in the back, in the cardiac region, are sometimes 
noted. The patient may grow nervous, sleepless, anxious, irritable, 
even delirious—a wonderful change from the former condition of 
mental hebetude or imbecility. The urine is increased in amount 
and may contain a little albumin or sugar. Cretins have the hair 
become soft and the teeth develop naturally; they may grow several 
inches in height in a single year, whereas for perhaps twenty years 
before not an inch had been gained. They learn to talk and to 
walk; the voice loses its harsh character and becomes soft and 
natural. It is a transformation from horribile dictu into mirabile 
dictu. 
A very few fatal cases in those already ill of some other organic 
disease, as of the heart, are reported. Murray lost two under these 
circumstances. Thomson1 reports a fatal case, where autopsy 
showed myocardial degeneration. 
If the theory as to the causation of myxedema be true, the 
artificially fed thyreoid extract merely supplies the chemical sub- 
i Edinburgh Medical Journal, 1893, p. 1014. THYREOID THERAPY 
5 
stance that is no longer elaborated by the absent or inactive gland. It 
need excite no surprise, therefore, to learn that in cases of myxedema 
relapse into the old condition soon follows the stopping of the rem- 
edy. Moderate doses have to be continued for indefinite periods. 
This is the experience up to the present date, at least. Murray 
reports1 that the first patient he treated by thyreoid feeding, in 
1891, is still alive and well, but that the treatment is still continued. 
What future trial will disclose, especially in the case of cretins after 
they have attained full physical and mental development, cannot be 
foretold. It is probable that in all cases, unless it be where a tem- 
porarily inactive gland can be roused to activity, the remedy will 
have to be continued for years or during life. 
In obesity. The rapid loss of weight that occurs in myxedema 
when the remedy has been employed, suggested its use in obesity, 
and the results warrant a trial in all cases. Kraus finds thyreoidin 
of greater value in anemic obesity than in that form accompanied by 
rosy lips, ruddy cheeks, good appetite, strong muscles. In all cases 
the action on the heart is to be watched. Diet may or may not be 
altered. Where great tendency to weakness is shown, a full nour- 
ishing diet should be allowed during the treatment. Relapses are 
common unless moderate doses are continued. Among those who 
give favorable reports may be mentioned Davies, Leichtenstern, 
Wendelstadt, Dercum, Barron, Hwald. 
Losses in body weight, even up to ten kilogrammes in six 
weeks, are reported.2 Kwald finds that the thyro-iodine answers 
fully as well in the reduction of weight as does the entire gland. 
Just why some cases are refractory and others amenable, is still not 
definitely settled. 
In struma. The outlook for improvement or cure in cases of 
simple parenchymatous goitre is good. Cures by the use of the raw 
glands, the tablets, the extract, and thyro-iodine, are reported by 
many: Bruns, nine out of twelve cases; Reinhold, five out of six; 
Ewald, eight out of eight; Leichtenstern, an unsuccessful case 
treated with the tablets; Stabel, in twenty-five cases four cured, 
twenty-one improved. Stabel prefers the fresh glands or fresh 
extract to the tablets, finding—if the glands are not decomposed— 
fewer unpleasant symptoms develop. 
The most elaborate report is that of Bruns, of Tubingen, who 
for two years has systematically treated goitre by the fresh glands, 
the tablets, and later by the thyro-iodine. His conclusions, briefly 
1 British Medical Journal, Feb. 8, 1896. 
2 Ewald’s report. 6 
THYREOID THERAPY 
put, are that the majority of cases of simple hyperplastic struma are 
amenable to treatment, improvement being seen ordinarily in from 
two to four weeks. The younger the patient and the younger the 
goitre, the better the prospect for permanent cure or decided im- 
provement. Relapse should be guarded against by long-continued 
use of moderate doses of the drug.1 
In tetany. Following removal of the thyreoid, tetany and 
other forms of spasm have been observed in man and in the lower 
animals. The use of the remedy in tetany was therefore tried. 
Some successes, at least temporary, are reported—e.g., by Breisach, 
Levy-Dorn. Others, as Jaksch and Gottstein, report no benefit or 
but slight and temporary improvement. It is probable that if tetany 
is due to varied causes, those cases only will be benefited that are 
due to the absence of the thyreoid antitoxin. Further observation 
on the thyreoid treatment of tetany is needed. 
hi skin diseases. The remarkable effect upon the subcutaneous 
tissue of feeding thyreoids in myxedema, the frequent desquama- 
tion, the replacing of the dry harsh skin by a softer and more natu- 
ral integument, the growth and improved quality of the hair, have 
led to the use of thyreoids in the treatment of skin diseases. Here 
reports are conflicting. Cases of psoriasis, of lichen, xeroderma, 
scleroderma, ichthyosis, lupus, etc., have been reported as improved 
or as having recovered, while negative results in similar cases have 
been obtained by others. As typical of these reports, and because 
the number of cases is unusually large, may be cited that report 
made by P. S. Abraham to the Medical Society of London. Of 
sixty-five cases of psoriasis, eighteen were improved; of the remain- 
der, some were worse, some unimproved, and in many the sjmip- 
toms of compelled the observer to stop the treatment. 
He reported the same uncertain results in other cases of .skin 
disease.2 
So far is the report of the dermatologists from being unanimous, 
that we must refuse as yet to accept it, and declare that they must 
be granted further time before bringing in a final and conclusive 
report. Thyreoid therapy in skin diseases is still sub judice. 
In mental disorders, epilepsy, etc. While there is a wonderful 
transformation in the mental state of the sufferer from myxedema 
after thyro-iodine has been administered, there is little theoretically 
or practically, to judge from the published reports, to warrant the 
hope of relief in psychoses not due to thyreoid inactivity. Perverted 
i Proceedings of Fourteenth Congress of Internal Medicine, reported in Centralblatt 
fur Klin. Med., April 25, 1896. 
2 British Medical Journal, Jan, 13, 1894. THYREOID THERAPY 
7 
mentality due to disease of the brain and not of the thyreoid will 
not respond to this treatment. 
In exophthalmic goitre. The employment of thyreoid extract 
in exophthalmic goitre seems contra-indicated on every ground. 
Symptomatically the two diseases, myxedema and exophthalmic 
goitre, are antitheses of each other. In the one there is mental 
dullness, slow heart, lowered temperature, dry, harsh and thick 
skin, atrophic thyreoid, eyelids drooping over a sunken eyeball. In 
the other there is mental excitability, irritable and rapid heart, nor- 
mal or slightly elevated temperature, moist, thin skin, enlarged 
thyreoid, prominent eyeballs with retracted lids. The most rational 
theory to-day is that exophthalmic goitre is hyperthyreoidea—too 
much thyreoid secretion. Overdosing with thyreoid extract pro- 
duces “ thyreoidism,” closely akin in its phenomena to exophthal- 
mic goitre, at times even to the presence of exophthalmos. The 
majority of clinicians who have employed thyreoid extract in 
Graves’s disease have had no good results or have aggravated the 
symptoms. Starr, in the Medical News of April 18, 1896, gives an 
excellent summary of the reasons why myxedema and exophthalmic 
goitre are diametrically opposed and cannot, therefore, be treated in 
the same way. In the one case the aim is to increase thyreoid secre- 
tion, in the other to lessen it. 
In this brief review of thyreoid therapy I have not aimed to 
present an array of authorities or of statistics. I have merely tried 
to present the conclusions one feels justified in drawing from a 
study of the work already done in the line of the employment of 
this remedial agent in various diseases. From such a study it 
seems to me that one may reach the following conclusions concern- 
ing thyreoid extract: 
1. It is curative in myxedema (idiopathic, cretinism, operative). 
3. Simple hyperplastic struma, particularly if in the young, is 
frequently cured or improved. 
2. Many cases of obesity are cured by it. 
4. In 1, 2, and 3, the remedy has to be continued for an indefi- 
nite time, to prevent relapse. 
5. It may prove of value in some cases of tetany. 
6. In skin diseases it is of doubtful value, to say the least. 
7. The same is true of mental and nervous diseases. 
8. In exophthalmic goitre it is contra-indicated. 
9. The results are practically the same whether fresh glands, 
extracts or dried glands are employed. 
10. This is probably true also of the thjao-iodine of Baumann. P«.ea Av wue determinate. 
_.-v*-;ssical.rind muse, hereafter, be consulted by every 
yTthe best work in this field.” 
“ Medicine” 
Hlv appearance of the first number of the second volume of Medicine, 
JL the monthly mpclical journal edited-by Harold N. Mayer, IVi. D., of Chi-, 
cago, and published by -George, S. Davis' of Delioit, prompts the just 
•comment- that no medical journal that we have seen at all approaches it in 
newness and beauty of typography or, in general, in tlffe quality of the 
printer’s and publisher’s work. ■ In.contrast with the host of so-called medical, 
journals, printed poorly upon inferior paper, it is, a keen pleasure to pick up, a 
number of JH(fdicing and realize wihal an important part ’the there mechanical , 
work put upon a journal plays. ' ’ : 
: It must not bfe concluded, however, that charm of appearance is the 
only gdpd quality of Medicine. It is. well edited and its pages are clean and 
free from any Objectionable feature. It deserves a- place among- the very 
foremost of . American . medical journals, and we sincerely wish .it a full 
medsure of success. The ,general quality of, medical journals of this coun- 
,try is so low chat the success of all the better otjes; is to be devoutly wished 
for by all physicians vdio feel a pride in American medicine. 
rHE Journal of Experiment''! Medicine, a periodical •to appear at 
-• , Mbe pub1* Hie be?.' '-a year by ,P 
Editorial in February Cleveland Journal of [Medicine. MEDICINE 
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HAROLD N. MOYER, M. D„ 
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VS:I may. 1896. , 
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