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Special Article
GLANDULAR PHYSIOLOGY AND THERAPY
THE PATHOGENESIS AND PREVENTION OF SIMPLE OR ENDEMIC
GOITER
DAVID
MARINE, M.D.
NEW
YORK
predicted.
accompanying chart.
So far
as
goiter,
but I cannot
view. Virchow's
view,3 that the various morphologic forms of goiter are
only terminal metamorphoses of a single initial type,
more nearly embraces the facts.
The structural unit of the thyroid is the follicle.
Normally it is a rounded, grapelike, closed vesicle
distended with clear viscid colloid (thyroglobulin).
The epithelial lining is composed of flat cuboidal cells
(never higher than cuboidal) arranged in a single layer;
the bases of these cells are attached to a delicate
vascular connective tissue framework. The cells are of
two types, as first determined by Langendorf : 4 (1)
chief cells and (2) colloid cells, and the necessary inter
mediate stages. These two types of cell occur in vary
ing proportions, but the chief cells in the normal gland
always predominate. The proportion of chief cells to
colloid cells can be varied and controlled experimentally,
and because of this the two types are considered as
indicating only different stages of secretory activity of
a single cell type. The chief cell is the actively secreting
cell and the colloid cell is the collapsed spent cell.
different forms,
find
even
of endemic
for such
adequate support
HYPERTROPHY
AND
HYPERPLASIA
y*
Exhaustion atrophy
Hypertrophy-> Hyperplasia*^
\.
Colloid goiter
4?
Exhaustion
atrophy
Oolloia goiter
content.
INVOLUTION
(COLLOID GOITER)8
compensatory hypertrophy following partial thyroidectomy, and following the administration of the thyro
3.
4.
gland
are
again
assume.
ATROPHY
While involution
or
pyknotic
or
atypical
cell
mass.
In the
more
advanced
intensity.
although occasionally
STRUMA
NODOSA
(ADENOMATOUS GOITER)
stimulating
the
substances.
The principal clinical diseases associated with dis
turbance of function of the thyroid may be grouped as
follows :
I. Thyroid insufficiencies :
1. Simple goiter (endemic, epidemic, sporadic).
2. Myxedema :
(a) Infantile (cretinism).
(6) Adult (Gull's disease).
II. Exophthalmic goiter.
The discussion of exophthalmic goiter is not part of
this paper, but certain features of this disease may be
referred to for comparison. Exophthalmic goiter is
not a primary thyroid disease. The thyroid reactions
in exophthalmic and endemic goiter are, however,
similar anatomically and are apparently the result of
increased pituitary (thyrotropic) activity. The anterior
pituitary is usually enlarged in simple goiter, while in
exophthalmic goiter it is not. In simple goiter the
pituitary stimulation is dependent on deficient thyroid
secretion, while in exophthalmic goiter the pituitary
stimulation, if present, is probably the result of a
deficiency of some factor or factors related to the sex
18
z.
u. z.
4:453, 1889.
16. Smith, P. E., and Smith, I. P.: J. M. Research 43:267 (June\x=req-\
1922.
July)
17. Marine, David; Rosen, S. H., and Spark, C.: Proc. Soc. Exper.
Biol. & Med. 32:803 (Feb.) 1935.
and
acid.\p=m-\Ed.
18.
Paracelsus,
2: 74, 1616.
A. P. T.:
De
most
briefly expressed by
on
institutions, in schools
where
goiter
was
districts.
21
22
25
19.
ment,
20.
tricts
Morel:
Paris,
Du
1864.
goitre
et du
Careful goiter surveys of the school population in selected disof the United States have been made by Olesen (Pub. Health
Rep. 44: 1463 [June] 1929) of the United States Public Health Service. A resurvey in the same districts with similar methods would be
of great value.
insulin.
Water has been associated as the carrier of the goiter
noxa by all peoples from the remotest times.26 All the
experiments so far conducted with water have yielded
negative or doubtful results. These results could be as
easily interpreted as indicating a deficiency of some
essential element, iodine, as indicating the presence of
some specific substance.
It is not in accord with the
facts to state that water in goitrous regions is always
polluted. There is the interesting experiment of Port
land, Ore., where the incidence of goiter rose sharply
after the introduction of the water from Mount Hood,
which, from the standpoint of organic contamination,
is one of the purest of waters.
One substance in water, calcium, stands out as an
important factor in goiter and has been considered an
etiologic factor for more than a century.27 The high
calcium content of water in many goiter regions is
significant, but there are many areas where the calcium
content is high without goiter and other areas where the
calcium content is low with goiter. This would indicate
that calcium is not an essential factor, though it
probably is an important contributing factor.
A low iodine content of water, food and soils in
regions where goiter was common was first established
by Chatin.28 His work was unfortunately discredited
and further advance was blocked for forty-five years,
until Baumann 29 and his pupils discovered the normal
30
criticism
occurrence of iodine in the thyroid. Hirsch's
of Chatin's work may be quoted as representative of
the prevailing opinion up to the time of Baumann's
discovery :
415, 1925.
38. Hellwig, C. A.: Iodine Deficiency and Goiter, Arch. Path. 11:
709 (May) 1931.
39. Thompson, J.: Influence of the Intake of Calcium on the Thyroid
Gland of the Albino Rat, Arch. Path. 16:211 (Aug.) 1933; Endocrinology 17:537 (Sept.-Oct.) 1933.
40. Zondek, H., and Reiter, T.: Klin. Wchnschr. 2:1344 (July 16)
1923.
41. Abelin, I.: Biochem. Ztschr. 199:72, 1928.
specific
antiseptic.
ent
hypotheses.
PREVENTION
transportation facilities
planning control.
48.
fundamental factor in
6: 325
49.
as
iodine.
Such
50.
51.
Marine, David, and Lenhart, C. H.: J. Exper. Med. 12: 311, 1910.
Klinger, R.: Schweiz. med. Wchnschr. 51:12 (Jan. 6) 1921.
McClure
69
goiter operations
of iodine-Basedow's disease and remove is low, and in Bern, where it is high, illustrate the influ
important objection to generalized iodine ence of goiter on thyroid carcinoma and indicate the
prophylaxis. In the Akron experiment, lasting three change that must take place when the incidence of
years, eleven instances of mild iodism and no case of goiter in the tumor age group is reduced. In Berlin
exophthalmic goiter occurred in 2,190 girls between the there were thirteen malignant thyroid tumors in 13,426
ages of 10 and 20 years. Klinger in 1921 did not necropsies, while in Bern there were 159 malignant
observe a case of iodism or of exophthalmic goiter in thyroid tumors in 15,250 necropsies.
more than 1,000 children observed over a period of
the
occurrence
the most
repeatedly
prophylaxis.
The daily amounts of supplementary iodine required
for prevention of goiter obviously must vary with dif
Council
The Council
on
63.
1924.
Centralbl. f.
Physical Therapy
Physical Theraty
has authorized
publication
ELECTROSURGERY
ent
on
DISCUSSION OF
DISADVANTAGES
INDICATIONS, ADVANTAGES,
AND WARNINGS
CERNING ITS USE
HARRY E.
CON
MOCK, M.D.
CHICAGO
produces
more
destruction,
homogeneous granular
dbris,
as