Individualization of the Patient in the Treatment of Hyperthyroidism
The association of hyperthyroidism with old age, extreme youth, heart disease, substernal goiter, or a poor preoperative response of the pulse curve, and with certain complicating diseases, presents a different problem in each instance from the standpoint of surgical treatment. Since it is not possible to set up a routine which is applicable to the management of every case of hyperthyroidism, patients in each of the groups mentioned should be given individual consideration. In short, the problem of the relative prognostic significance of the various factors which constitute warnings in patients with hyperthyroidism will be studied in regard to the specific complications which must be guarded against in each group of patients.
II. Treatment of Thyroid Crisis
It is extremely significant that in the past 10 years, exactly one-half as many patients have died from hyperthyroidism in the Cleveland Clinic Hospital before any operative procedure had been undertaken as have died following operation for hyperthyroidism. This means that the hyperthyroidism which we see has advanced in many instances beyond the stage of curability.
Fifty-eight per cent of these patients who died in the hospital without operation died as a result of thyroid crisis, and ninety-four per cent of the patients who died from thyroid crisis without operation were delirious when they were admitted and died within five days of the time of entry. These figures indicate that if a patient in crisis survives the reaction incident to transportation to the hospital, there is a 94 per cent chance. . .