The surgical conquest of hyperthyroidism, initiated at the turn of the century and established in safety by the preoperative use of iodine, had become so well accepted that until the introduction of thiouracil, few chose to consider hyperthyroidism anything other than a surgical problem. Today, as a result of the discovery of powerful and effective drugs, the controversial issue of whether hyperthyroidism is better treated by conservative (medical) management has again arisen.
Even before the introduction of thiouracil the mortality rate of hyperthyroidism treated by experienced surgeons was less than 1 per cent. Improvement in anesthesia, in surgical technic, in preoperative and postoperative care, and a keener appreciation of the factors that increase the risk of operation contributed materially to this advance. Since at the present time the safety of thyroidectomy performed by a competent surgeon is about the same as that of thiouracil therapy, the decision as to which is the treatment of choice must be decided on the basis of end results and morbidity.
When hyperthyroidism arises as the result of functional activity in a long-standing adenoma, it is not surprising that removal of the benign tumor which is responsible for the hyperthyroidism is followed by cure of the disease and an almost negligible incidence of recurrent hyperthyroidism. The factors responsible for the development of the original adenoma may no longer be in operation, and if excision has been complete, there is no reason for the hyperthyroidism to recur.
In diffuse goiter with hyperthyroidism, however, the entire gland. . .