Effect on Total Thyroidectomy on Response to Adrenalin

Abstract

The following observations have been carried out as a part of the study concerning the therapeutic value of total thyroidectomy in angina pectoris. It was noted a few years ago 1 that intramuscular injections of adrenalin, when given to patients suffering with angina pectoris would provoke attacks of anginal pain. As a result of clinical observation, it was found that when total thyroidectomy was performed in patients who were having daily attacks of angina, these attacks disappeared immediately following the operation and long before any changes had taken place either in the basal metabolism or in the rate of blood flow. It was therefore suspected and, in fact, predicted 2 that removal of the thyroid gland might be producing a fundamental alteration in the response of the circulation to adrenalin and that a previously positive response might possibly become negative after such an operation.

Five patients were given intramuscular injections of adrenalin varying from 0.3 to 0.5 cc. of a 1–1000 solution before and 2–3 days after operation. In the first of these cases, which was operated upon August 22, 1933, 0.5 cc. before the operation induced a maximum rise of the pulse rate of about 20 and the blood pressure rose from 188/88 to a maximum of 226/94 in a few minutes. Typical substernal anginal pain also resulted. On August 23, 1933, 0.5 cc. of adrenalin produced no pain, a rise in the pulse rate of only 10 and the blood pressure was hardly changed. On August 26 0.5 cc. of adrenalin again produced no chest pain, although the systolic blood pressure rose about 30 mm. On August 27, 1.0 cc. of adrenalin again failed to produce anginal pain and the effect on the pulse and blood pressure was slight. Here, although twice the original amount of adrenalin was given, the effect on the pulse rate and blood pressure was less and there was no chest pain.