Propyl Thiouracil in the Treatment of Hyperthyroidism

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The medical treatment- of hyperthyroidism is much more satisfactory today than it was even such a short time ago as the early part of this year. A year ago thiouracil had already been proved capable of controlling all types of hyperthyroidism, whether associated with Graves' disease or with adenomatous goiter, except when crisis was present or impending. It was used with outstanding success in the preoperative preparation of severely ill patients and those in whom complete control of hyperthyroidism before operation was an especial advantage. It was used successfully in many cases as the sole method of treatment.

There were two great obstacles to the general use of thiouracil. The first was the risk of severe agranulocytosis, known to occur in as many as 3 per cent of the patients and fatal in perhaps half of these. This was comparable to the surgical mortality in good hands and might have been an acceptable risk except for the second obstacle. This was our lack of knowledge as to the rate of recurrence of the disease after the withdrawal of treatment. It is this fact which still tips the balance slightly in favor of surgery in many patients, since the rate of recurrence of hyperthyroidism following subtotal thyroidectomy competently done is probably not more than 5 per cent in Graves' disease and much lower in adenomatous goiter.

For reasons such as these it has been our policy to recommend thiouracil only for those patients in whom the risk of surgery or complications. . .



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