OBSERVATIONS ON AN UNUSUAL CASE OF MYXOEDEMA

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Abstract
The case of a non-cretinous woman without goitre and with longstanding hypothyroid complaints is described. The basal metabolism was low, serum cholesterol and body weight high. Thyroid function, as measured with tracer doses of 131I, was normal. Total serum proteinbound iodine (PBI) was normal, but the butanol-extractable fraction was very low. Exogenous hormone, thyroxine as well as triiodothyronine (T3), was hardly effective even in the very high dose. The turnover of radiothyroxine (T4*) was markedly retarded. Prednisone reduced the butanol-insoluble fraction of the PBI and completely normalized the turnover rate of T4*. However, during prednisone therapy the effective dose of T3 was still very high; after cessation of prednisone this same dose of T3 was effective and the turnover rate of T4* (high) normal. These observations are thought to favour the hypothesis that in this case there existed two, presumably separate, disorders: 1) the formation and secretion by the thyroid of an abnormal (butanol-insoluble) iodinated compound, and 2) an impaired peripheral utilization of normal thyroid hormone.