RECURRENT AND PERSISTENT HYPERTHYROIDISM*

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Abstract
THE writer's earliest years in surgical training and practice were during a period when the classic operation for bilateral goiter was a bilateral, partial resection, then improperly labeled “subtotal.” Perusal of operative records of such cases regularly reveals such estimates as “twothirds of one lobe and five-sixths of the other were removed.” The inadequate results of such a procedure were late in being evaluated, as in the case of gastro-enterostomy or limited resection of the stomach for duodenal ulcer. That the results were far from ideal was shown by the unwillingness of many internists to use the word “cure” to describe the usual sequelae of partial thyroidectomy. Surgeons were still unaccountably influenced by Kocher's earlier dictum that postoperative hypothyroidism should be feared and was to be classed as a complication of thyroidectomy in the same undesirable category as nerve injury or hypoparathyroidism. This attitude was maintained despite the fact that the ability of desiccated thyroid substance and thyroxine, administered orally, to restore and maintain normal metabolic status had been amply demonstrated in the treatment of spontaneous myxedema.

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