Myxoedema in Young Women.

Although the nature of the relationship between the thyroid gland and the gonads is undetermined (Spence 1953) it is well recognized that the incidence of clinical subthyroidism and myxoedema is far greater in women than men, and highest at or after themeno pause*. Green (1951), however, says that the demand of the body for thyroid hormone is greatest in women at puberty and during pregnancy and lactation, and it is perhaps surprising, therefore, that the development of subthyroidism soon after a normal confinement appears to be uncommon, judging by the very few references in the literature. Fraser and Garrod (1955), in their paper on " Primary myxoedema apparently dating from post-partum shock ", mention that primary myxoedema may first become evident during the post partum period, but give no references and search ofthe literature is almost completely unrewarding. However, Roberton (1948,1959) wrote on "Lassitude, Coldness and Hair Changes following Pregnancy, and their Response to Treatment with Thyroid Extract" (a paper which received a Sir Charles Hasting's prize); and " Mild Hypothyroidism in General Practice" (and this paper is essentially about the same syndrome that he described 11 years earlier). In my experience Roberton's syndrome commonly brings women for laboratory investigation and, now-a-days, I largely confine tests to haemoglobin estimation and a suggestion that precautionary chest x-ray be done. In this syndrome, loss of libido is also common and fear of another pregnancy may complicate the picture. Typically, the woman with the Roberton syndrome is slim or thin with thyroid gland impalpable so that the tracheal rings are easily felt. After a few weeks on a small daily dose of thyroid some patients firmly express physical and mental betterment, with the loss of libido as the last feature to