Changes in the mental condition of the patient are frequently to be recognised as one of the earliest symptoms of exophthalmic goitre. These mental changes may be present before the cardiac or ocular symptoms have been established and before the changes in the thyroid have been observed. The most common feature is an intense and indefinable agitation leading to a more or less marked motor and mental restlessness, which causes the patient to look for constant change in her surroundings and work. There is an inability to settle long to any one occupation or recreation. Work begun with a feeling of relief at the change involved soon becomes irksome, is then done only with an effort, and with the cumulative feeling of effort and concentration required soon causes distress and the work is laid aside. Any sudden noise, any unexpected news, any of the ordinary disturbing elements of everyday life may be followed by an attack of palpitation lasting some hours, and yet, in spite of this, there is an imperative desire to keep moving; to go where such incidents may be experienced. Dr. Geo. Murray, in the Bradshaw Lecture of 1905, states that he has not noticed this craving for entertainment. It seems to be entirely a question of degree. If the stimulus is moderate there may be pleasure in its fulfilment; if more marked it may pass into an apprehensive dread with inhibition of this desire.
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