Results of Nonsurgical Treatment of Hyperthyroidism*
IN considering therapy for hyperthyroidism, it is important to keep clearly in mind the type of disease with which the hyperthyroidism is associated. This is because the choice of management of the hyperthyroidism may be influenced by the characteristics of the goiter itself.
Hyperthyroidism may arise in one of three types of goiter:
The diffuse goiter of Graves’ disease (fig. 1).
Multinodular or so-called adenomatous goiter (fig. 2).
Discrete adenoma (fig. 3).
Some of the outstanding features of these three conditions which have important influences on diagnosis and choice of treatment are outlined in table 1.
Graves’ disease may be considered a systemic disease of which hyperthyroidism is just one part. At present, it appears plausible that it arises in the nervous system emanating through the anterior lobe of the pituitary gland. According to current theory, it is the excess of the pituitary thyrotropic hormone which causes the diffuse thyroid hyperplasia. This change supplies the visible evidence of the abnormal increase in activity of thyroid cells producing the excess of thyroid hormone. Eye signs may not be noticeable in some cases throughout the course of the disease, in some they advance with the hyperthyroidism, and in some they demonstrate that they are not the result of thyroid hyperfunction by appearing months or years before or after hyperthyroidism has become present. This disease may occur at any age, but is common under 40 years. The goiter may be small and barely palpable or it may reach a size. . .