The Treatment of Myxoedema 
by 
Feeding with the Thyroid Gland 
By Henry Hun, M. D. 
Professor of Diseases of the Nervous System 
in the Albany Medical College 
Read before the Albany County Medical Society 
on December 13th, 1893. 
Reprinted from the Albany Medical Annals, 
January, 1894. The Treatment of Myxoedema by Feeding with 
the Thyroid Gland.* 
By Henry Hun, M. D., 
Professor of Diseases of the Nervous System in the Albany Medical 
College. 
There are, doubtless, many things in medicine of more 
importance, but few of greater interest, than is the subject of 
myoxoedema. Although the disease is not common, yet, 
neither is it of extreme rarity, and whenever seen, it presents 
on the first glance such striking diagnostic features that it is 
strange it was not noted as a distinct form of disease before 
1874, when Sir Wm. Gull described it in a paper entitled: 
“ On a Cretinoid State Supervening in Adult Life in Women.” 
In 1877, Dr. Ord (whose name since that time has been most 
intimately associated with myxcedema) published a report of 
many other eases of this disease, to which he for the first 
time gave the name of myxoedema, believing that the 
essence of the disease lay in a mucin yielding oedema, and 
stated the most important fact, that at the autopsy of persons 
dead from this disease the thyroid gland was either atrophied 
or its structure replaced by fibrous tissue. In 1882 and 1883 
Reverdin and Kocher each published papers showing that a 
condition identical with myxoedema was produced in con- 
sequence of the total extirpation of the thyroid gland. Thus, 
ten years after the disease was first described it was referred 
to its final cause—the loss of the thyroid gland—a gland 
whose function up to that time had been merely a subject for 
hypothesis. 
*Read before the Albany County Medical Society on December 13th, 1893. 2 
During the next few years the proof that myxoedema was 
due to the loss of the function of the thyroid gland became 
more and more positive and in 1889 and 1890 many attempts 
were made to graft a lobe of the sheep’s thyroid in the peri- 
toneal cavity and in the sub-mammary region of persons 
suffering from this disease with gratifying but imperfect 
success. Finally in 1891 and 1892 patients with myxoedema 
were given the thyroid gland by mouth, at first in the form 
of a glycerine extract, next in the form of the gland itself 
slightly cooked and at last in the form of the dried powdered 
gland. Cases treated by either of these methods improved 
rapidly and were soon cured, although it was found necessary 
to continue to give the gland from time to time or relapses 
would occur. 
Two cases of myxoedema treated by feeding with the dried 
thyroid gland I wish to report briefly to-night. It is not 
necessary to go into minute detail, for the success of this 
treatment is already well established. The first of these cases 
is one of four which formed the basis of a paper on myxoe- 
dema which I published in 1888. His case was reported 
under the name of Mr. Y. and he is the only one of the four 
now living. He always drank and smoked to excess and 
continues to do so now. He contracted syphilis in 1877 and 
was thoroughly treated for it, partly at home and partly at 
the Hot Springs of Arkansas. In 1883 the myxoedematous 
symptoms first made their appearance and steadily progressed 
in intensity until he presented a typical picture of the disease. 
He never perspired. The skin was dry and scaly, the 
epidermis peeling off in great quantities, and presented a 
slight yellow tinge, which was especially marked on the face 
and on the scalp. The complexion was waxy and on friction 
spots of congestion appeared on the cheeks and persisted a 
long time. The whole top of the head appeared bald, but on 
close inspection was found to be covered with short brittle 
stumps of hairs. The nails were riged and brittle and on the 
latter account troubled him greatly. The face was everywhere 
swollen and pitted very slightly only on long continued pres- 3 
sure. The under eyelids were baggy and wrinkled. The 
lips were especially swollen, much everted and of a bluish 
color. The tongue and the tissues of the larynx were swollen 
and the voice was rough and hoarse. He was very susceptible 
to the cold and was accustomed to go to the south-west with 
the advent of cold weather. He was physically weak, his 
mind was sluggish and he slept much of the time. 
The disease reached its height toward the end of 1884 and 
remained stationary throughout 1885. There was then a 
slight improvement until 1887, since which time his 
condition remained without material change until July 24, 
1893, when he presented himself for treatment, he never 
before that time having been under my professional care. He 
was given three times daily a capsule containing five grains 
of the dried thyroid gland prepared by Parke, Davis & Com- 
pany and he continued to take ten or fifteen grains daily with 
occasional intermissions during four months. At the present 
time he takes the thyroid at the rate of fifteen grains a day 
during one week in each month. The effect of the treatment 
has been very decided and has resulted in a complete 
cessation of all his unpleasant symptoms. The skin is no 
longer scaly and he perspires freely when he is warm. He 
is no longer sensitive to cold and he is not covered by half 
the bed clothes that he formerly required. He even takes a 
cold plunge bath in the morning and can dress in a cold bath 
room. He formerly slept twelve and fourteen hours out of 
the twenty-four, but now sleeps only seven or eight. His 
speech is quicker, he writes more easily and he walks more. 
He feels quite well • and his appearance no longer suggests 
myxoedema. 
The second case is that of a woman, Mrs. McM., 48 years 
old, who was sent to St. Peter’s Hospital from Fonda, for 
relief from a supposed abdominal tumor. She was admitted 
into the service of Dr. Hennessey, who could discover no 
abdominal tumor further than the pendulous abdomen so com- 
mon in case of myxoedema, and who recognizing the case as 
one of myxoedema, transferred her to me for treatment. 4 
Her history is briefly as follows: She has had no children 
and no miscarriages. Her menstruation has always been 
regular in time, but somewhat excessive in quantity. Three 
years ago she suffered from two “ floodings” and since that 
time has not menstruated. Several years ago her hair began 
to fall out and has continued to do so; at the same time her 
teeth and gums became sore, some teeth fell out and others 
became loose, and at about the same time her legs became 
swollen and have remained so ever since. She “catches 
cold ” upon slight exposure and is much more unpleasantly 
affected by cold than was the case formerly. She is physically 
weak, can walk only a short distance and even then suffers 
from dyspnoea. Her mind seems sluggish and stupid. Her 
complexion is sallow with a spot of congestion on each cheek. 
Her under eyelids are wrinkled, baggy and translucent, her 
lips are swollen and everted, a number of her teeth have 
fallen out and the top of her head is bald. Her legs are 
swollen and pit but very slightly on long continued pressure. 
The skin of the arms and legs is scaly, the abdomen is large 
and pendulous; there is no hair in the axilla or on the pubes, 
and no thyroid gland can be felt. All the patient’s actions 
are performed slowly, her speech is slow and her voice hoarse. 
The patient was given three times daily a capsule contain- 
ing five grains of the dried thyroid gland, prepared by Parke. 
Davis & Company, and continued to take them during three 
weeks, at the end of which time she had improved in all 
respects. She was more active, perspired more freely, her 
skin was less scaly and her appearance had changed so much 
chat the diagnosis of myxoedema could hardly have been 
made. She was so much better that she left the hospital and 
I have not seen her since. 
In the progress towards recovery which these patients made 
under the influence of the thyroid treatment, two interesting 
symptoms appeared which occurred also in almost all the 
reported cases that were treated in this way. The first of 
these symptoms is a decided loss of weight. The man lost 
twenty-three pounds in two months, but later when his health 5 
was restored he began to gain again and eventually regained 
eleven pounds, leaving a permanent loss of twelve pounds. 
The woman lost nine pounds in the first two weeks of treat- 
ment and was not subsequently weighed. 
It would seem, therefore, that the thyroid gland taken 
internally possesses the power of reducing weight. Such has 
been found to be the case. Putnam* tried it in two cases of 
ordinary obesity, one of which lost forty and the other forty- 
eight pounds, and similar results have been obtained by 
others. I have tried it in a few cases of obesity with satis- 
factory results. I will mention only one case in which it was 
put to a rather hard test and yet acted well. Those of us 
who have had any experience in attempting to reduce 
obesity, whether by diet or otherwise, are aware that during 
the first few days or first week or two there is a decided 
loss of weight, but that after the initial loss a further reduc- 
tion in weight either does not occur or occurs very slowly. 
The one case of obesity treated by the thyroid gland, which 
I wish to report is that of a lady, who, without the slightest 
change in her diet, had been taking phytolene and had lost 
seven pounds in weight, but then remained stationary in spite 
of large doses of the drug. The phytolene was then stopped 
and she was given five grains of dried thyroid gland three 
times daily, with the result that she lost a little over three 
pounds in two weeks, which is quite a loss considering that 
the patient made absolutely no change in her usual diet. 
The thyroid gland, therefore, taken internally, appears to 
have the power of reducing weight in other cases than those 
of myxoedema. It must always be remembered, however, 
that several sudden deaths from syncope under the thyroid 
treatment have been reported and that in cases of fatty and 
degenerated heart the remedy should either not be used at all 
or should be given cautiously in very small doses. 
The second interesting symptom, which occurs in cases of 
myxoedema while under the thyroid treatment, is a great 
restlessness and nervous excitement, which is very different 
♦Transactions of the Associations of American Physicians, vol. viii, 1893, P- 34°- 6 
from the sluggish placid manner customary in myxoedema, 
and is usually so intense as to necessitate temporary cessation 
of the treatment. This conditisn of nervous excitement is 
very similar to that which is a prominent symptom in 
exophthalmic goitre, and it would seem that myxoedema and 
exophthalmic goitre are two diseases presenting symptoms 
the one the direct reverse of the other, and that in myxoedema 
the symptoms are due to a loss of the function of the thyroid 
gland, while in exopthalmic goitre directly opposite symptoms 
are produced by an excess of function of the thyroid gland. 
If this is true then the essence of exopthalmic goitre and the 
cause of the symptoms is in the goitre and the quickest and 
most radical form of treatment would be to extirpate a portion 
of the enlarged gland. This is a dangerous operation, but it 
has now been performed a number of times in cases of 
exopthalmic goitre with gratifying success. Putnam* closes 
an able article on “Thyroidectomy in Graves’ Diseases” with 
the following words: “ In all, the summary includes fifty-one 
cases. There were four deaths attributable to the operation, 
but in almost all the rest greater or less improvement, and 
often, substantial cure seems to have taken place. Of course 
these results are not to be placed entirely to the credit of the 
operation, since prolonged rest is almost always beneficial, 
and the influence of time is often of itself useful and even 
curative.” 
It would seem, therefore, that in casse of exophthalmic goitre 
where prolonged rest, electricity and large doses of quinine 
and iron have failed to give relief, thyroidectomy may 
result in a complete cure or in decided relief of distressing 
symptoms. 
These two symptoms: The rapid loss of weight and the 
condition of nervous excitement, which occur so uniformly un- 
der the thyroid treatment, are of great importance, not only in 
establishing a relationship between myxoedema and other 
diseases, and in showing the immense influence which the 
thyroid gland exercises on the nutrition of the body, but also 
*Journal of Nervous and Mental Diseases, December, 1803. 7 
in indicating possible new therapeutic uses for the gland, the 
value of which must be proved or disproved by future clinical 
experience. Whether or not any other pathological conditions 
besides myxoedema will be found to yield to the internal 
administration of the powdered thyroid gland, there can 
be no doubt that this disease can be almost invariably cured 
by it. 
We have, then, in myxoedema a disease which remained 
during centuries unrecognized and yet as soon as it was 
described, it was seen to possess such striking characteristics, 
that a diagnosis could be made with almost absolute certainty at 
the first glance. In less than ten years after it was first 
described, it was definitely referred to its cause(the loss of the 
thyroid gland), and ten years later it could be cured with 
almost absolute certainty (by eating the thyroid gland). Such 
a rapid referring a disease to its cause, and thereby finding its 
certain cure, is unfortunately an occurrence of great rarity in 
medicine, and justifies the statement made in the opening 
sentence of this paper, “That few things in medicine are of 
greater interest than is the subject of myxoedema.”