A Study of the Gastric Secretion in Hyperthyroidism Before and After Operation

Abstract

Gastric symptoms have long been associated with hyperthyroidism. The reports of studies attempting to correlate these symptoms with disturbances in gastric secretions are not uniform. Several investigators (I, 2) report an increase in the hydrochloric acid and total volume of secretion. One (3) contends there is no characteristic secretion in exophthalmic goiter. A greater number (4-16) report a diminution or absence of hydrochloric acid in hyperthyroidism and in the feeding of thyroid extracts to animals. Excellent reviews of the subject have appeared in recent papers by Moll and Flint (9), Brown (10), and Lerman and Means (13). With the development of a more accurate method for determining the degree of gastric acidity by histamine stimulation it seemed desirable to restudy the problem. Accordingly, a survey was begun eighteen months ago to determine the behavior of gastric secretion in hyperthyroidism before and after operation. Since the beginning of this work, Lerman and Means (13) have reported a study of gastric secretion in exophthalmic goiter before treatment using a similar method. METHODThe present generally accepted technique of gastric analysis was employed in this study. A fasting specimen was withdrawn, followed by the ingestion of 50 cc. of 7 per cent alcohol. Specimens were removed at twenty and forty minute intervals. If the last specimen contained no hydrochloric acid, histamine (ergotamine acid phosphate) 0.1 mgm. per ten kilograms was given subcutaneously and specimens were withdrawn at twenty and forty minute intervals. The volume, free hydrochloric acid and total acidity of each specimen were determined. T6pfer's reagent and phenolphthalein respectively were used as indicators and the results expressed as the number of cc. of N/1O NaOH necessary to neutralize 100 cc. of gastric juice.Two analyses were done on each patient before preoperative iodine therapy was begun, a third the day before operation, and a fourth the day of discharge. The patients were followed by subsequent analyses at intervals of one to two months. We have arbitrarily classified the results upon the basis of the highest acid content obtained after the stimulation by alcohol and histamine: (1) Normals, those patients in whom repeated analyses showed free hydrochloric 753

Gastric Acidity and Gastric Biopsy in Thyrotoxicosis

“…We have shown that in some cases active thyrotoxicosis can depress the secretion of acid by the stomach temporarily, even in the A.H.T. Berryhill and Williams (1932) suggested that an imbalance between the sympathetic and parasympathetic nervous systems was responsible for this phenomenon. In man vagotomy reduces the secretion of acid in response to augmented histamine stimulation (Gillespie and Kay, 1961), and in conscious dogs with gastric fistulae stimulation of the vagus conspicuously increases the maximal histamine acid output (Marks, Komarov, and Shay, 1960).…”

“…Histamine 70 30% Alcohol Caffeine Brown et al (1941) Vanzant et al (1932) .. Polland (1933) Lander and MacLagan (1934) Ruffin and Dick (1939) Winkelstein (1942) .. Doig et al (1950) .. Moll and Scott (1927) noted that achlorhydria was more common in patients with a long history of thyrotoxicosis, and Wolpe (1912) and Lerman and Means (1932) thought that achlorhydria could be correlated directly with the severity of the disease. On the other hand, Berryhill and Williams (1932) found that the incidence of achlorhydria was not related to the age of the patients, the duration of the symptoms, or the degree of elevation of the metabolic rate, though it appeared to be a manifestation of active thyrotoxicosis, because acid was detected in 19 of the 34 patients with achlorhydria when they were re-examined six months after operation. Louis and Wills (1937) made similar observations.…”

Gastric Secretion in Hyperthyroidism

“…Since then many studies of gastric secretion in such patients have been undertaken, and a high incidence of achlorhydria has been reported (Moll and Scott, 1927;Brown, 1930;Lerman and Means, 1932 ;Berryhill and Williams, 1932 ;Wilkinson, 1933; Louis and Wills, 1937;McElroy et al, 1938;Brown et al, 1941). The relative incidence ranged from 12% (McElroy et al, 1938) to 68% (Berryhill and Williams, 1932) and hypochlorhydria was frequent in those not achlorhydic.…”

“…Since then many studies of gastric secretion in such patients have been undertaken, and a high incidence of achlorhydria has been reported (Moll and Scott, 1927;Brown, 1930;Lerman and Means, 1932 ;Berryhill and Williams, 1932 ;Wilkinson, 1933; Louis and Wills, 1937;McElroy et al, 1938;Brown et al, 1941). The relative incidence ranged from 12% (McElroy et al, 1938) to 68% (Berryhill and Williams, 1932) and hypochlorhydria was frequent in those not achlorhydic. As in most cases acid secretion returned or increased after treatment (Berryhill and Williams, 1932;Wilkinson, 1933;Louis and Wills, 1937), a functional change in the gastric mucosa, possibly related to overactivity of the sympathetic nervous system, was suggested as the cause of impaired acid secretion.…”

“…The relative incidence ranged from 12% (McElroy et al, 1938) to 68% (Berryhill and Williams, 1932) and hypochlorhydria was frequent in those not achlorhydic. As in most cases acid secretion returned or increased after treatment (Berryhill and Williams, 1932;Wilkinson, 1933;Louis and Wills, 1937), a functional change in the gastric mucosa, possibly related to overactivity of the sympathetic nervous system, was suggested as the cause of impaired acid secretion. No consistent relationship was found between the presence or absence of achlorhydria and the age of the patients or the severity of the disease, but it was thought to be more frequent in those with symptoms of longer duration (Moll and Scott, 1927;Wilkinson, 1933 ;Louis and Wills, 1937).…”