Chapter 20: Bronchocele; Exophthalmic Goitre
This is a chronic enlargement of the thyroid gland. Other tumors of the neck may be mistaken for goitre, but the latter may be diagnosed by directing the patient to imitate the act of swallowing. If the tumor follows the motion of the larynx and trachea, and at the same time occupies the natural situation of the thyroid gland, there can be but little doubt of its nature. Goitre is not, in itself, a painful disorder, nor does it taint the system. It has no quality of malignancy about it. It is always a deformity because of its weight; when very large it may cause distress and suffering. The worst sects from goitre are its interference with the circulation and the respiration. By its pressure, it may obstruct the free descent of the blood through the veins of the neck, and give rise to headache, giddiness, noises in the ears, confusion of thought, and a turgid condition of the head and face. Or, by pressing upon the esophagus, it may cause hoarseness, wheezing and dyspnea. It may even impede deglutition. It may surround all the front and sides of the neck, like a thick collar, and rise as high as the ears, or it may hang down in a pendulous lump and be supported by the chest.
This disease is much more common in females than males. In forty-nine cases of goitre treated in one hospital in ten years, forty-eight were women. On an average, we have twenty females, for one male, who are afllicted with this malady. I am inclined to the belief that any uterine disease acts as an irritant and helps to increase the size of the goitre. Because of this I feel confident that a cure could not be expected if the uterine trouble is allowed to take its course. It has been noticed that the goitre seems to take on new life and activity during pregnancy and also during the menstrual periods. In America the disease is sporadic, but in Italy, Switzerland, Asia and certain parts of England it is endemic; The disease is quite common in localities where the water contains much lime; in such localities as many as 80% of the population are afflicted with this disease.
TREATMENT
In taking a case of goitre for treatment it is always best (if the patient is a female) for the physician to make sure that there is no uterine disease as the contributing cause. If there is anything of that kind, it must be attended to if we expect to cure the case. In thinking of the treatment for this condition, iris versicolar is one of the first remedies that comes to our mind. In my experience, I have found that the best preparation of this remedy is a saturated tincture made when the plant is in flower. Take the fresh roots, mash them and add eight ounces to a pint of 80% alcohol. Let it stand for fourteen days, then filter, The dose of this preparation is twenty-five drops after each meal. With this remedy internally:I have made some fine cures. Externally I use the following prescription:
Tinct. Iodine,
Tinct. Phytolacca root; a. a. 3s. s.
Mix. Sig. Paint this over the enlarged gland with a camel's hair brush night and morning.
There are some who claim that iodide of lime is a cure for all cases of goitre, but in actual practice we find that it is not. In some recent cases I have given the remedy in one-third grain doses once in three hours for one week, and thereafter two-thirds of a grain once in three hours.
Iodine has been given internally in goitre but it is best adapted to simple, recent and soft goitre, and especially when there is aggravation of all the symptoms in a warm room. Give iodine sixth decimal dilution, ten drops in a little water once in two hours. In cases of goitre where there is a hard lumpy feeling to the swelling and it is of long standing I like iodide of barium, third decimal trituration, three tablets once in three hours.
Phytolacca must not be forgotten if the disease is complicated with enlargement of the tonsils. Give phytolacca, five drops once in three hours. Externally use the following prescription:
Specific Medicine ( Lloyd's)
Phytolacca root, 3ii.
Glycerine, gii.
Mix. Sig. To be well rubbed into the growth three times a day.
An ointment of the biniodide of mercury, three drachms to a pound of lard, is sometimes beneficial. This ointment is to be well rubbed in and heat applied either from the sun's rays or by artificial means. This should be repeated twice a day. Internally give biniodide of mercury, third decimal trituration, three tablets once in three hours.
When there is a creamy, yellow coating on the tongue, and a feeling of pressure on the throat from the growth, natrum phos. is the needed remedy. Give three grains of the third decimal trituration three times a day. In goitre with irregular hard lumps and a sense of suffocation after sleep, spongia is the indicated remedy. Use the third decimal trituration and prescribe three tablets every three hours.
There is no such thing as a specific for any disease. Examine each individual carefully and be sure that you give the indicated remedy. Then you may expect good results. In my experience I have never known a case of goitre to be cured by an operation. Therefore if I had the disease it would be my choice to employ medical treatment, with a reasonable expectation of a cure. Do not forget the uterine complication in goitre.
EXOPHTHALMIC GOITRE
In this disease there is palpitation of the heart and of the arteries of the head and neck, an enlargement of the thyroid gland and an exophthalmia. This disease occurs most frequently between puberty and the menopause. Men are rarely afflicted with the disease; out of 200 cases only thirty-nine were males. Persons of a neuropathic tendency are the most predisposed to this auction. Chlorosis, menstrual disorders and mental worry are usually the contributing causes of this disease. In the premonitory stage we notice a certain irritability without any well defined cause, and mostly in persons of a nervous temperament. They are no longer even tempered; soon the face assumes an expression that corresponds with sudden discontent and fleeting anger. The eyes are very prominent and staring with fullness of the blood vessels behind the eyeballs which causes the protrusion. These symptoms slowly increase for a time until the eyes are forced forward in a most unnatural manner. The eyes present a brilliant moist appearance and lachrymation is observed frequently. Vision is normal and the pupils are not altered. When the eye is cast downward the upper lid does not follow as in health. The cardiac palpitation and arterial throbbings constitute the principal symptoms of the disease. The cardiac palpitations are extremely violent and associated with excessive pulsations of the arteries of the neck and head. The goitre develops after the palpitations have existed for some time. It is usually large, soft, and, to the touch, resembles an aneurysmal tumor. The right lobe of the thyroid is the one which is the most enlarged. During the paroxysms very violent throbbings are felt in the tumor, which may double in size in a few hours, and will assume its former size after the paroxysm is over. The principal points to be remembered in the diagnosis of this disorder are bulging of the eyeballs, cardiac palpitations, and when the eye is cast downward the upper eyelid does not follow as in health.
TREATMENT
Belladonna is indicated when there is redness of the face, dilatation of the pupils, arterial throbbings in the neck and head, quick pulse, and cardiac palpitation. Give tincture Belladonna, third decimal dilution, twenty drops in half a glass of water, one teaspoonful once in two hours. Tincture ephedra vulgaris is indicated when there is a sensation as though the eyes were being pushed out with the tumultuous action of the heart Prescribe this remedy in ten drop doses once in two hours.
Tincture lycopus virginicus is needed when the eyes are prominent and staring, with dyspnea oppression of the chest and cardiac palpitation. Give this remedy in fifteen drop doses once in three hours. In severe cases it is wise to give the maximum dose of thirty drops four times a day.
Tincture fucus vesiculosus should be prescribed when your patient is under thirty years of age. In recent cases the dose should be half a teaspoonful twice a day. In well developed cases a teaspoonful of the tincture fucus should be given three times a day. Tincture veratrun veride is indicated when the pulse is full with a hardness and tension to it. Prescribe it in doses of ten drops of the first decimal dilution once an hour for three hours, then once in three hours until the pulse feels soft and regular.
Iodide baryta. A feeling of hardness in the goitre would indicate iodide baryta. Use the third decimal trituration and give three tablets once in three hours, As a local application for this auction I like the following prescription:
Tinct. Phytolacca,
Tinct. Iodine, a. a. 3i.
Mix. Sig. Paint over the enlarged gland twice a day with a camel's hair brush.
