The Roentgen Therapy of Exophthalmic Goiter

Abstract

IT is not the intention of the essayist to precipitate an argument with the surgeon or the internist. We do not intend to claim in the progress of this paper that the X-rays will cure all types of goiters or even all exophthalmic goiters. I am sure from past experiences that we are cognizant of the limitations of radiation. To claim in an unqualified manner that the X-rays are a panacea in all types of goiters is to bring the profession into disrepute. That there are cases that respond to surgery is a known and accepted fact; that some patients respond and get well under rest is also a known fact; that there are cases that can be cured by X-rays is also true. In this symposium, talking of cures, we must all admit that there are cases that have hitherto failed to respond to surgery, rest or the X-rays. In these refractory cases the close co-operation of the surgeon, intemist and roentgenologist is imperative. In our thyroid work at St. Luke's Hospital we have enjoyed the close co-operation of an internist, Dr. N. C. Gilbert; a surgeon, Dr. H. E. Mock, and a pathologist, Dr. Arthur Rissinger. Each patient is gone over very carefully before deciding what is the best method of treatment. In this discussion of roentgen therapy we will consider chiefly the exophthalmic type of gaiter, but we believe, however, that good results can be obtained with any type of hyperfunctioning thyroid, although not with equal certainty. It is a well established fact that in the treatment of the exophthalmic type of goiter the X-rays are of great value, and in the majority of cases a cure can be obtained. In the treatment by means of the roentgen rays it is important that the patients be properly selected. There are doubtless cases that should be referred to surgery at once; among these would be cases where mechanical pressure of the enlarged gland upon the trachea or other structures causes symptoms. There are a few other cases where surgery appears to be more efficient in the light of our present knowledge. What the determining factor is, I am not prepared to say. I am, however, equally certain that many of the cases now operated upon would do better under roentgen therapy. Every patient with a high metabolic rate, without pressure symptoms, should be treated with the X-rays. From past experiences we feel that all cases should be hospitalized; the results will be better and certainly more prompt. Patients should be kept in the hospital during treatment and the succeeding week, when possible, as the metabolic rate may take a sharp rise following treatment, even doubling in some instances. During the period between the seventh and fifteenth day the metabolism recedes to the initial rate and then usually starts to fall lower. It is not advisable to place these patients in a general ward where patients seriously ill or convalescent are either complaining or telling of their past and present ailments.