Tetany following extirpation of the thyroid / by Francis J. Shepherd.

  • Shepherd, Francis J. (Francis John), 1851-1929.
Date:
[1912]
Catalogue details

Licence: In copyright

Credit: Tetany following extirpation of the thyroid / by Francis J. Shepherd. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    8/10 (page 672)
    was much larger than I had thought and went behind the sternum and into the thorax. Not liking to leave so large a piece of gland in such a position I decided to remove it, and tied off the upper horn of the left lobe, leaving a considerable portion of thyroid tissue, then tied the inferior thyroid artery, and pulled up the lower part projecting into the thorax. In doing so I looked carefully for parathyroids but failed to find any. I then cut off a piece the size of half a large egg which lodged under the sternomastoid and was still connected with its bed by con- nective tissue, and left it there, the whole of the rest of the gland coming away together in one piece. The operation was rather prolonged, but the patient had stood it well and was in first-rate condition. A tube was introduced and the wound closed. Next day there seemed to be some dis- tention of the neck, and a clot of blood filled the tube and on its removal a good deal of bloody serum escaped. On January 18 (third day), the patient complained of a feeling of formication over the whole body and of a great weight which pressed on her brain. She had slept well the night before and had a normal pulse and temperature. Toward evening she complained of severe pain at the base of both lungs and next day felt dizzy and had numbness of the legs and feet. On January 20 (fifth day), in the early morning she felt fairly well but complained of numbness and tingling in the legs and face and a feeling as if ants were crawling over her skin. A few hours later she had cramps in both hands and pains in the joints and considerable stiffness of the fingers and flexion of the toes. Then there were severe paroxysms in both arms and legs. The thumbs were contracted in the palm of the hand, the fingers flexed at the metacarpophalangeal joint, the wrist flexed, and elbows bent. The toes were flexed and adducted and the feet extended. She complained of great pain in the legs, which was at times spas- modically increased; her face twitched and there was numbness and stiffness about the jaws. Chvostek’s sign was well marked, and pressure on a nerve trunk produced spasms (Trousseau’s sign). Pulse was 80 to 100, and she had no temperature. Her voice was very husky and she seemed stupid; she complained most of the acute pain in the legs, which at times was very severe. As soon as I saw her I put her on drachm doses of the lactate of calcium every three hours. This was about eleven in