Arch Surg. 1940;40(6):1123-1132. doi:10.1001/archsurg.1940.04080050086008.
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Toxic goiter is as different in its various clinical manifestations as it is in its pathologic appearance. The young person with an acute fulminant exophthalmic type of thyroid disease often resembles but slightly the much older patient with a mildly toxic nodular goiter who presents a cardiac or a nutritional problem. Indeed, this marked discrepancy in clinical types has led many to assume the existence of at least two separate clinical entities, exophthalmic goiter on the one hand and nodular toxic goiter on the other hand. In the United States, Plummer and Boothby have been strong adherents to this dualistic conception. There are others who feel that the varied manifestations of thyroid disease represent different reactions on the part of the patient to the same basic pathologic process. Von Bergmann, one of the enthusiastic supporters of this so-called unitarian conception, has recently made an effort to show that there is


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