Hyperthyroidism, results of treatment--an appraisal.

We have come a long way since Mackenzie wrote these words in 1905, and yet in one sense they are still true. It is not that the modern modes of treatment are of doubtful value; all are effective, but the ideal treatment for hyperthyroidism still eludes us. Neither do we have reliable methods of selecting the best treatment for the individual patient. This could be arranged more rationally if it was possible to predict which patients would undergo spontaneous remission without therapy and which would suffer protracted and serious illness. The aim of treatment is to reduce the secretion of the thyroid gland to a level which supports normal metabolic processes, to prevent complications and to correct those already present. Specific measures which reduce the secretion of the toxic gland effectively are antithyroid drugs, subtotal thyroidectomy and radioactive iodine. Opinions differ about their relative merits and no well-controlled comparisons of the three methods appear to have been made. The purpose of this paper is to report the experience gained in the Metabolic Unit of the Royal Victoria Hospital in treating patients with hyperthyroidism and to make an appraisal of their advantages and disadvantages. Table I shows how some of our patients have been managed over the last 14 years. All these have been subject to special analysis and study. Some have had more than one form of treatment. Antithyroid drugs and surgery have, of course, been continued since 1967, although not analysed for the purpose of this presentation.