THE PATHOGENESIS OF CRISIS AND DEATH IN HYPERTHYROIDISM

Abstract

The physiology of the thyroid gland is probably as well understood as that of any organ of the body, yet there is much that is not clear with regard to the many pathologic states which result in disordered function of this organ. There has been difficulty, particularly in understanding that curious state referred to as thyroid crisis, a condition often terminating in death either prior to or, frequently, after operation, the pathogenesis of which is rarely made clearer by postmortem examination. In this state it is obvious there are profound toxemia and a violent and overwhelming disturbance of metabolic processes with, no doubt, a profoundly altered blood chemistry if, as remarked by Maddock,¹"one only knew what to measure." Twenty years ago it was not uncommon for patients to be admitted to the hospital in active crisis and to succumb rapidly in spite of treatment. As patients and physicians