Roentgen-ray Treatment of Hyperthyroidism

Abstract

HYPERTHYROIDISM is a condition which concerns especially the general practitioner, the endocrinologist, the ophthalmologist, the surgeon, the radiologist, and, in fact, enters at times, as a complicating factor, into almost every other branch of medicine. It is quite proper, therefore, that this subject should be studied in its various phases in this Post-graduate Institute. My interest in the treatment of hyperthyroidism dates from 1904, or about thirty-five years. I am pleased, therefore, that I should be called upon to discuss the irradiation treatment of hyperthyroidism. Thousands of cases of hyperthyroidism have now been treated and recorded by various authors (Borak, Ginsburg, S., Groover, Christie and Merritt, Harris, Holzknecht, Loucks, Menville, and others). I have myself written on this subject on six previous occasions. The results in general have shown about 65 per cent cures, about 20 to 25 per cent marked improvement, and about 10 per cent failures. This is also approximately the records obtained by surgery. In other words, about 90 per cent have been restored to working ability. The general practitioner is usually the first to come in contact with a case of hyperthyroidism. To him belongs the responsibility of making the diagnosis, and its differentiation from other similar clinical syndromes, and he should remain in charge until the patients are restored to a normal condition and until they are able to carry on their occupation. Treatment does not consist merely in treating the thyroid, either by irradiation or operation, but the predisposing and exciting causes should be removed, and after active local treatment the patient should be guided and guarded by competent medical advice such as the general practitioner can give. Crile says: “In 3.3 per cent of our total cases, there is a recurrence of the hyperthyroidism after partial thyroidectomy. In every case in which this occurs, it will be found that there has been a persistence of the agents which were active in producing the primary hyperthyroidism—focal infection, social maladjustments, worry, overwork or some other strain.” It is well known to you all that patients who are suffering from hyperthyroidism associated with a goiter postpone the consultation with their family physician for fear he or she will be sent to a surgeon for operation. To avoid such delays and to conserve the patient's energy, it is, therefore, well to remember that irradiation therapy is approximately of equal value with surgery in the end-result, and if patients learn that not all cases must be operated upon, they will be less likely to delay consultation. In dealing with hyperthyroidism, we must assume that there is an overgrowth or a new-growth of the thyroid gland, or a hyperjunction of the normal amount of glandular tissue.