Lives in Distress

TLDR: The authors conclude that the " achillogram " is reliable as radioiodine uptake and better than the B.M.R. and the serum cholesterol and also reliable in a given patient when the results of treatment are being followed over a period.

Abstract: This monograph from the School of Nancy deals with muscular disorders associated with thyroid dysfunction. It is perhaps the only book to cover the ground so fully in this field. Good clinical accounts aregiven of the conditions which are undoubtedly due to thyroid disorder, such as acute and chronic thyrotoxic myopathy. There is also a good account of the relationship between thyrotoxicosis and periodic familial paralysis, with its surprisingly high incidence in Japan. No fewer than 250 ot the published cases come from that country, whilst only 30 have been recorded in Europe and the United States altogether. The writers also refer to the association between myasthenia gravis and thyrotoxicosis, and they side with those who do not believe in the so-called see-saw relationship by which myasthenia is said to worsen if the thyrotoxicosis is treated. They find strong support in the literature for the view that the two disorders often behave quite independently of each other. In considering all these conditions the authors base themselves mainly on published material, which they analyse and discuss fully. There is little contribution from their own experience. Their particular interest has been the duration of the ankle jerk in the diagnosis of thyroid dysfunction. They have used the measurement in milliseconds (ms.) from the moment of percussion of the tendon to a point half-way down the relaxation gradient. This empirical end-point was used because the end of relaxation is blurred on the tracing and cannot be precisely defined. Undoubtedly there is a fairly wide overlap, so that 25%/ of hyperthyroid patients are in the doubtful 260-280 ms. range, whilst as many as 30% of myxoedematous patients are in the equally doubtful 320-360 ms. range. The diagnostic value of the test is therefore greater in excluding rather than in proving a given thyroid dysfunction. The authors conclude that the \" achillogram \" is reliable as radioiodine uptake and better than the B.M.R. and the serum cholesterol. The test is also reliable in a given patient when the results of treatment are being followed over a period. This book has an extensive bibliography, no fewer that 705 references being given. The Anglo-Saxon and German literatures are widely and accurately quoted as well as, of course, the French. As a reference book it will be of great value to the neurologist as well as the endocrinologist.