TREATMENT OF TOXIC ADENOMATOUS GOITER BY LARGE DOSES OF RADIOACTIVE IODINE*

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Abstract
AT TIMES surgery is eliminated in the selection of a method of treatment for toxic adenomatous goiter, either because the patient refuses it or because his physical condition makes him a poor surgical risk. The therapy usually next considered is the administration of an antithyroid drug, such as propylthiouracil. This method is highly useful in preoperative preparation or as definitive treatment in selected cases of Graves' disease, but unfortunately has several drawbacks in the treatment of multinodular goiter. Many months of therapy may be necessary before the hyperthyroidism is controlled, the remission effected may be only temporary, and in a few patients the drug has to be discontinued because of toxic effects. Therefore, the administration of radioactive iodine, although not considered the treatment of first choice in most cases, may become first choice under certain circumstances. Previously, the dosage plan in the treatment of toxic adenomatous goiter has generally consisted of an initial dose of less than 20 millicuries, followed by small doses as necessary. In some instances, the total amount of radioactive iodine used has been as much as 100 millicuries (1). The disadvantage of this plan is the long period before hyperthyroidism is adequately controlled (2, 3)—usually from six to twelve months.

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