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JAMA. 1918;71(5):327-330. doi:10.1001/jama.1918.02600310005002.
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The intimate interrelationship of the endocrine glands and the nervous system is nowhere better illustrated than in the symptomatology of exophthalmic goiter. Though it is now generally agreed that in exophthalmic goiter we have to deal with a thyrointoxication, it is not surprising that the syndrome has been and still is described as a nervous disease, since many of the symptoms recognizable in this disease are admittedly due to disturbances of the neural and psychic functions. Of the four cardinal symptoms of exophthalmic goiter—tachycardia, struma, tremor and protrusion of the eyeballs—no less than three are due to abnormal innervations; and when the host of less striking manifestations of the disease is considered, it is clear that neuropathic and psychopathic phenomena predominate. Even in the disturbances often looked on as non-neural in origin—the changes in the blood, the metabolic disturbances, the disorders of endocrine glands other than the thyroid— there may


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