Malignant exophthalmos: Malignant exophthalmos and unusual instances of toxic goiter present some of the most serious problems with which the ophthalmologist has to deal in treating diseases of the glandular system. This group of patients requires special consideration and attention, first, because in the true cases, no exophthalmos existed before operation and secondly, because a review of the histories of these patients reveals certain features which make one realize that structures other than the thyroid gland must be involved, although the clinical picture is largely that of hyperthyroidism. The pulse rate may not be extremely high and the loss in weight may not be great. The basal metabolic rate is inconsistent and usually is not so high as would be expected in cases in which a great deal of weight has been lost.
True malignant exophthalmos appears after operation. The patient notices that the eyes are beginning to protrude and this progresses if no treatment is received. When the patients are seen early, the use of thyroid extract up to the point of tolerance often checks the progress of the ocular changes. Large quantities of glandular extract are tolerated well, but the medication must be controlled by repeated estimations of the basal metabolic rate. The edema is that of a severe myxedema, both in the upper and lower lids, and the patients may gain weight. Unless care is exercised, these patients may be thought to have recurrent hyperthyroidism, and a second thyroidectomy may be performed which may result. . .