A FOUR-YEAR STUDY OF THE TREATMENT OF HYPERTHYROIDISM WITH METHIMAZOLE*

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Abstract
Methimazole (1-methyl-2-mercaptoimidazole) was administered to 184 patients for control of their hyperthyroidism. Initial daily doses varied from 15 to 60 mg. and maintenance doses from 2.5 to 30 mg. Periods of treatment ranged from 14 days to 4 yrs. Lugol''s soln., 10 minims 3 times daily, was added to the regime in the 37 patients prepared for surgery. In other patients one minim daily was employed as soon as the patient was euthyroid and continued for 3 months following cessation of antithyroid compound therapy. With adequate dosage 75% of the patients showed improvement during the 1st week of treatment. From 2 to 26 weeks were required to bring the thyrotoxic state under control. Eighty-five percent of the subjects became euthyroid within the 1st 5 weeks. In the majority treatment was associated with a gain in weight, a reduction of pulse rate, pulse pressure and systolic blood pressure, a lowering of the basal metabolic rate and elevation of the levels for serum cholesterol, and the disappearance of positive symptoms and signs. The size of the thyroid was increased in 12, decreased in 45, and showed no appreciable change in 33 of the 90 patients in whom observations were made. Toxic manifestation, including pruritis, rashes, edema, urticaria, fever and granulocytopenia, occurred in 8 of the 184 patients. Patients under 35 years of age were more responsive than older subjects and it was in this group that the high percentage of "cures" occurred. It is concluded that methim- azole is a rapidly acting, relatively safe antithyroid compound.