Twelve years' experience of antithyroid treatment.

SINCE thiouracil was introduced to clinical therapeutics in I943, antithyroid treatment for thyrotoxicosis has widely increased and proved more and more effective as the years have passed, partly as the result of experience but also through the use of more effective agents, such as carbimazole and methimazole. It is thus possible now to assess their relative value in comparison with surgical treatment, which before I943 was the only treatment possible and still is the treatment of choice for a proportion of cases sent to the physician in consultation. Recently Trotter (I96I) reviewed his experience over a period of io years using thiouracil and methyl thiouracil. He found that it was necessary to abandon treatment in 44% of 70 cases owing to the presence of too large a goitre in some cases and, in others, on account of the necessity for prolongation of courses for more than two years. 45% were satisfactorily maintained euthyroid for io years and a smaller number (3I%) were given courses of less than two years' duration. Yet for patients successfully treated the inconvenience of hospital admission, the anxieties and fears of operation and the disadvantage of permanent hypothyroidism-sometimes seen following both operation and radioiodine-have been avoided. The present paper illustrates the improved results using carbimazole, and the merit of particular care both in the selection of suitable patients and in dosage control. In I948 I commenced the careful selection of suitable cases for medical treatment from those sent for opinions, at the same time referring those to surgical colleagues considered unsuitable for antithyroid therapy. The present study is of the results and potentiality of treatment with methyl thiouracil since 1948 and carbimazole since 1953. The chief value of the study lies in the personal selection of cases and control of therapy by one doctor, with the helpful co-operation of clinical assistants through courses of treatment and follow-up periods. Throughout I have had the co-operation of surgical colleagues who have operated on all cases referred to them and who have themselves referred several cases for antithyroid therapy. Clinical Material Since I948, 27I cases of thyroid disorder have been referred for personal opinions concerning treatment and diagnosis, and in all these, pathological enlargement of the thyroid was apparent. Of 194 cases showing toxic features, 32 cases were referred direct for surgical treatment, which was invariably carried out. The high proportion selected for antithyroid therapy is no doubt attributable, to a certain extent, to preliminary selection of cases by general practitioners and surgical colleagues. Most of these patients were seen at out-patient clinics dealing primarily with general medicine, while about 25% were seen in private practice.