The Radiologic Aspect of Thyrotoxicosis

Abstract

IN the surgical fraternity it is common to hear depreciation of the treatment of thyrotoxicosis by radiation therapy. It is said by some that, because surgery has been shown to offer a large percentage of cures with a low mortality rate, there is no need for any other method of treatment. In a few large surgical clinics of this country, excellent results have been obtained in the treatment of toxic goiter by operation, with a low mortality rate. Unfortunately, such brilliant results are not representative of those obtained by the general surgeons, who are, perhaps, competent in other fields of surgery, but lack the skill and experience so necessary in goiter surgery. Perhaps their attitude of opposition to radiation therapy would be altered if reliable statistics could be obtained on the number of cures, improvements, failures, and deaths following operation for toxic goiter by the general surgeon. If it were possible to procure such statistics, no doubt a certain number of cures and a surprisingly large number of failures and deaths would be revealed. In one of the largest surgical clinics in America, 10,781 cases of simple toxic and exophthalmic goiter were operated on during the period from 1924 to 1930, inclusive, with a mortality rate of 1.17 per cent. This small percentage of deaths is truly remarkable and speaks well for the great skill of certain American surgeons, who, on account of their wide experience in goiter operation, have become experts. If such a low mortality rate represented the results obtained by general surgeons throughout this country, there could be but a slight argument for any other form of treatment. Unfortunately, this mortality rate does not prevail. MacLean (1), in 1921, made a survey to ascertain the surgical mortality in exophthalmic goiter, sending questionnaires to 100 American and Canadian hospitals. The replies indicated that a mortality rate of 8 per cent existed at that time. Some time later, he sent questionnaires to 200 additional hospitals, and obtained about the same percentage, the mortality rate being then 7 per cent. In 1929, Cooke (2) stated that there was a general increase in surgical mortality rates during recent years, and that thyroid surgery headed the list, with a mortality rate which had increased 250 per cent in the preceding two decades. He believed the reason for this increase to be that every local surgeon to-day operates on goiter cases, while several years ago operation was done by only a few experts. There are many causes which produce deaths during and following surgical operation for toxic goiter, which have been divided into immediate and post-operative causes. The causes for immediate deaths, according to C. Mayo (3) are: 1. Hemorrhage 2. Air embolism 3. Myocarditis 4. Suffocation or the anesthetic. The causes of post-operative deaths are: 1. Pneumonia 2. Sepsis 3. Tetany, or myxedema.