Princess' Goitre

During the summer of 1933 a frantic debility manifested itself in Her Royal Highness Princess Mary, Countess of Harewood, only daughter of King George and Queen Mary. Physicians noted a toxemia which they believed due to a focal infection in her appendix. Sir Frederick Stanley Hewett, Surgeon Apothecary to the King, had a complete surgical unit set up in Princess Mary's Mayfair home, and there the following November her appendix was removed. One of the consultants in the case was Dr. Louis Francis Reobuck Knuthsen, a West Indian who achieved eminence as a London skin specialist.

Princess Mary recovered from the appendectomy uneventfully. But her quick excitability and easy fatigue did not disappear. The slightest exertion set her atremble. These and other peculiarities led Lord Dawson of Penn, the King's personal physician, Dr. Knuthsen and Sir Thomas Peel Dunhill, an Australian who achieved eminence as a London thyroid surgeon, to conclude that Princess Mary suffered with exophthalmic goitre.

Last week, after a cheery visit from the King and Queen, Princess Mary went to a private sanatorium to have her goitre out. A curving incision was made into the front of her neck. By lifting the flap of skin, the surgeon exposed the thyroid gland lying around the windpipe, excised almost all of it. He took special pains not to damage Mary's laryngeal nerves, which might cause her to choke to death, nor her parathyroid glands, which might throw her into spasms. Final step in the thyroidectomy was to bring the edges of the divided skin of the patient's throat together so neatly that each layer butts exactly against its companion layer.

Bedside bulletins indicated that this ticklish operation went off satisfactorily last week. For a few months Princess Mary's neck will show a thin red line, thereafter a thread of scar almost impossible to discern.

The physiological mechanism which produces exophthalmic goitre remains a medical puzzle. In typical cases the thyroid is enlarged and the eyeballs protrude from their sockets. But neither pop eyes nor big neck are essential symptoms of exophthalmic goitre. A rapid pulse, moist skin and loss of weight, despite a good appetite, suggest the disease. The patient is restless and irritable, laughs and cries easily, becomes angry and excited at the least provocation, is comparatively insensitive to cold. An unfailing test for exophthalmic goitre is the basal metabolism rate, measured by a simple breathing machine. If after a long rest in bed, her lungs consume 50% to 100% more oxygen than a normal person, the suspect undoubtedly has an overactive thyroid. Women are much more often afflicted than men.

Rest palliates the stormy symptoms of exophthalmic goitre. The only cure is subtotal excision of the troublesome thyroid. The patient immediately calms down. After a time the pop eyes usually recede.

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