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Astwood1has reported that diethyl thiobarbituric acid (thiobarbital) has antithyroid activity similar to that of thiouracil. Experiments on rats showed that thiobarbital in small doses was somewhat more effective in inhibiting thyroid function and perhaps less toxic than thiouracil. In larger doses, however, animals receiving thiobarbital were noted to have fatty infiltration of the liver. Astwood has been using thiobarbitol in clinical hyperthyroidism since February 1944 and has made a report on his results.1a The opportune moment for our initial trial use of thiobarbital came in October 1944 when a patient receiving thiouracil developed a fever reaction necessitating discontinuance of treatment and in whom further antithyroid therapy was thought essential before thyroidectomy. This first patient to receive thiobarbital (chart 1) was an extremely fragile woman aged 75 with severe hyperthyroidism of five years' duration due to an adenomatous goiter. She weighed 83 pounds (37.6 Kg.) and had a

The state of pregnancy demands increased secretion of the thyroid gland. If the gland is normal and the supply of iodine in the body is adequate, this increase of thyroid secretion will be sufficient. 1 C. H. Mayo and H. S. Plummer 2 stated: A supply of iodine inadequate for the proper functioning of the thyroid gland, followed by a subnormal delivery of thyroxine to the tissues, produces hypothyroidism; consequent elevation of intensity of thyroid stimulation causes diffuse hypertrophy of the thyroid gland; the secretory processes are altered; the diffuse hypertrophy disappears; colloid is stored in excess of the normal, and diffuse colloid goiter is the result. In many cases the sustained stimulation of the thyroid gland, in conjunction with unknown factors, causes the development of new tissue, adenomatous goiter.... The enlargement of the thyroid gland in pregnancy, whether of adenomatous tissue or of the entire gland from the storage

There is some misunderstanding, even yet, among certain of the profession with regard to the action of iodine in the various types of goiter. It is generally recognized that iodine in any form (we use aqueous solution of iodine, Lugol's solution, as a routine) causes a very beneficial response when used in exophthalmic goiter. This occurs practically without exception, but the iodine is especially useful in the preoperative treatment of exophthalmic goiter. We do find "iodine fast" cases of exophthalmic goiter or patients who have been overtreated with iodine. These patients, as a result either of a developed tolerance to iodine or of excessive overactivity of the thyroid, finally reach a stage at which their toxic symptoms fail to recede with iodine medication and may even progress. We do not know just how or why this occurs, but it does occur. To be entirely on the safe side, one should

For several decades writers in this country and abroad have reported the coincident finding of glycosuria in some cases of hyperthyroidism. Joslin and Lahey,1in their recent study of 500 cases of disease of the thyroid, reported the occurrence of glycosuria in 38.6 per cent of 228 cases of primary hyperthyroidism and in 27.7 per cent of 83 cases of adenomatous goiter with secondary hyperthyroidism, as compared with only 14.8 per cent in 189 cases of nontoxic goiter and 13.6 per cent of patients without diabetes or any disease of the thyroid gland. In a series of 100 dextrose tolerance tests which I2did in 82 cases of hyperthyroidism and 10 cases of colloid goiter, there was a fasting glycosuria in 19 per cent. In table 1 are given the reports of various authors as to the incidence of glycosuria in cases of hyperthyroidism. When chemical analyses of

The relationship, or rather the lack of relationship, between diseases of the thyroid and pregnancy is not well understood, and most of the literature on the subject is confusing and often misleading. This may be attributed, first, to a failure to differentiate clearly the various thyroid diseases, and, secondly, to carelessness in differentiating and excluding those syndromes which simulate thyroid disturbances, but are not due to them. The various types of goiter, according to the classification of H. S. Plummer, 1 are: (1) diffuse colloid goiter of adolescence; (2) adenomatous goiter without hyperthyroidism; (3) adenomatous goiter with hyperthyroidism, and (4) exophthalmic goiter. Marine and Kimball 2 have shown that diffuse colloid goiter and probably also adenomatous goiter without hyperthyroidism can be prevented in school children by administration of iodine. The development of these diseases is associated, as H. S. Plummer has pointed out, with potential, if not actual, hypothyroidism. The

Danger lurks at the bathing beach for those who are hypersensitive to cold, but the danger can be eliminated by adequate desensitization. We do not pretend that, scientifically, this is the most interesting implication of the present report; we do believe that now, with summer almost at hand, it is the most immediately applicable feature of our work. The study represents a clinical and experimental investigation of twenty-two cases, seven of which have been previously reported, illustrating the various phases of hypersensitiveness to cold. This constitutes the entire group of such cases observed at the Mayo Clinic during the past ten years. The ages of these subjects ranged from 15 to 59 years. Eleven of the subjects were females and eleven were males. With few exceptions they appeared to be in good general health; some were even robust. One subject also had osteitis deformans and one a hyperfunctioning adenomatous goiter