FOR THE first time in the history of surgical treatment of the thyroid, it is now possible to operate on all types of toxic goiter with comparatively little risk. While effective in the preoperative and postoperative care of exophthalmic goiter, iodine has not been effective in lowering the operative risk in cases of advanced toxic adenoma. Thiouracil and propylthiouracil (thiourea derivatives), on the contrary, are extremely beneficial in preparing both exophthalmic goiter and toxic adenoma for operation. Thiouracil, because of its tendency to cause toxic reactions and, especially, granulocytopenia, has been largely abandoned for the much safer propylthiouracil.
From a study of 170 cases of hyperthyroidism in which treatment was with propylthiouracil during the past two years, some conclusions have been reached.
1. After several months' treatment, patients with advanced multiple toxic adenoma with a serious cardiovascular condition may be operated on with almost as little risk as patients with