Pericarditis and Complete Heart Block during Thiouracil Therapy.

Mrs. G. W. was first admitted to hospital in 1932 at the age of 21 with a diagnosis of thyrotoxicosis. Both lobes of the thyroid were uniformly enlarged, and a fortnight after admission the right lobe and the isthmus were removed. During convalescence she developed nasal catarrh with fever, and Mr. Pavey-Smith reported that both tonsils were infected. At the same time the histological report on the excised portion of the gland revealed a simple colloid goitre. Nevertheless, a month later the left lobe was removed and the tonsils were left in situ. Following this she kept in good health until 1942, when she began to suffer from a recurrence of tonsillitis and from symptoms of thyrotoxicosis. In February 1944 she was seen by Mr. Pavey-Smith at Riponw-Hospital, who found the tonsils to be flat and red, with some pus in the crypts. In view of the symptoms of thyrotoxicosis he advised admission to Harrogate for investigation. Unfortunately this took place during his absence owing to illness, and his house surgeon, unable to find the evidence of tonsillar sepsis, referred her to the surgeon, who thought that a further thyroidectomy might be needed, but desired first to know if she might be a suitable case for thiouracil. On examination she was flushed and anxious with a fine tremor. There was slight exophthalmos. The heart was not enlarged and there were no murmurs. The basal metabolic rate was +27. The blood sedimentation rate was normal. She had never suffered from rheumatism. Thiouracil was started on April 14 in doses of 0-2 g., five times daily. Further estimations of the white cells and of the basal metabolic rate were made as shown below.