THE CURRENT TREATMENT OF HYPERTHYROIDISM*

Abstract

Propylthiouracil is a valuable drug for controlling hyperthyroidism, but because of its potential toxic side effects and the high incidence of relapses after its withdrawal, its use as the method of choice in the total treatment of exophthalmic goiter has not been established. As a means of preparing the patient for operation, medication with iodine has proved adequate except for a small group of patients whose operative risk is high because of severity of hyperthyroidism or because of complications. For this group, treatment with propylthiouracil is valuable as an additional measure of prepn. The surgical mortality rate for patients with toxic goiter prepd. according to the foregoing method has been low (0.18%). Treatment with radioiodine is an effective means of controlling the disease in many cases of hyperthyroidism. The permanence of the results cannot now be detd. Until greater accuracy in gauging the dose is established and until the potential radiation hazard in the treatment of hyperthyroidism with radioiodine is known, caution demands that employment of this drug be limited to patients for whom thyroidectomy is regarded as unduly hazardous. Thyroidectomy after prepn. with either strong I soln. alone or strong I soln. and propylthiouracil is the most conservative method of treatment for the majority of patients with exophthalmic goiter. The short time needed for this method of treatment, the speed of control of hyperthyroidism, the high incidence of permanence of control, and the low incidence of morbidity and mortality make surgical treatment a method which must still be considered in most cases of hyperthyroidism and which will be the treatment of choice in many instances.