Introduction

Myxcedema, goitre, and malignant disease of the thyroid are the special diseases of the thyroid gland. Diet is, in general, not an important factor in the treatment of these disorders. At the same time, and more especially in that type of goitre known as exophthalmic goitre, diet is in many cases of considerable importance.

In myxcedema no special dietetic instructions are called for; plain, simple, nutritive food is indicated.

In the case of simple goitre, the view has been expressed that the cause of this disease is the use of a drinking-water rich in lime, this theory being based on the prevalence of goitre in certain districts where the water has this property. More recently, however, the view has been expressed that this disease is the result of some infection arising probably from the intestinal tract. The exact causation, however, is vet unknown. With regard to the dietetic treatment, the diet should be of the nature of plain, simple food, largely lacto-vegctarian in character. Red meats should be used very sparingly, fish, chicken, tripe, and sweetbread supplying the meat foods. Care should at the same time be taken to see that the drinking-water does not contain excess of lime.

Exophthalmic Goitre

In exophthalmic goitre or Grave's disease there is very frequently severe gastro - intestinal derangement, such as loss of appetite, flatulence, or diarrhoea, and in these cases dietetic treatment is of the first importance. Careful attention must also be paid to the hygiene of the mouth, to thorough mastication, and to the prevention of constipation in this disease. It is in every case essential to make a careful study of the previous dietetic history of the patient, so as to determine whether the diet has been such as to derange the digestive tract. The most usual defects in the dietary are excess of starchy foods, too much tea, and, less frequently, excess of rich meat foods. It is likewise important to examine carefully the stools; the presence of ill-formed, fcetid stools points to an abnormally septic state of the intestinal tract, and the passage of scybalous masses would indicate constipation, both of which necessitate treatment.

In acute cases it may be advisable to put the patient on an almost exclusive milk diet for some days or longer, the diet being restricted to 2 or 3 pints of milk (which may, if necessary, be peptonised or administered in the skimmed form), and 1 pint of strong beef-tea. If diarrhoea be present, lime-water may be given in the milk.

In subacute and chronic cases all that is required is that the diet should be carefully regulated. Excess of starchy foods should be avoided as leading to abnormal fermentative changes; meat foods should be restricted, so as to diminish putrefactive changes in the intestines and also lessen the strain on the thyroid gland. The diet should be light and nourishing, and the drinking of buttermilk should be encouraged. The following is an appropriate diet list: -

Breakfast: 8 A.M. - Cup of tea. Bread and butter. (Sugar and jam or marmalade should be taken very sparingly.) Fish or egg.

11 A.M. - Glass of milk, or buttermilk. Luncheon: I P.M. - Bowl of soup made from good vegetable stock; or piece of fish or chicken. Bread and cheese. Celery, or a little fruit.

(On days when no soup is taken, a glass of milk or buttermilk may be recommended.) 4 P.M. - Cup of tea. Thin slice of bread and butter. Dinner: 7 p.m. Either - Soup, meat, pudding; or Meat, pudding, savoury.

With regard to this meal the following points should be noted. Soups should occasionally be of vegetable and occasionally of animal stock. The meat course should frequently consist of fish, chicken, rabbit, tripe, or sweetbread in place of the heavier red meats. Care must be taken with the use of root vegetables; occasionally they are better withheld. Suet puddings and pastry are not advisable. Curds, custard, milk puddings, or stewed fruit are the most suitable puddings. Cases of exophthalmic goitre are occasionally met with in which the appetite is keen and the state of the motions satisfactory, where marked benefit accrues from the use of a more liberal diet, such as is employed in cases of neurasthenia.