The Present Status of the Treatment of Toxic Goiter*

THIS paper presents a brief summary of the various methods of treatment of toxic goiter that are available at the present time and the current attitude toward them. Until a few years ago it was generally agreed that the best method of treatment was a subtotal thyroidectomy after adequate preoperative preparation with iodine, a high-caloric diet and rest. Various details had been perfected so much that the mortality from surgical procedures had dropped to about 1 per cent in leading clinics. In the past few years treatment has been greatly modified by the use of antithyroid drugs and radioactive iodine. There are five methods of treatment available at the present time: 1. A subtotal thyroidectomy after adequate preoperative preparation with propylthiouracil, iodine and a high-caloric diet. 2. Medical management with antithyroid drugs. 3. Medical management with radioactive iodine. 4. Roentgen ray treatment of the thyroid. 5. Roentgen ray treatment of the pituitary. In spite of the advances which have occurred, it is the consensus that the best method of treatment of toxic goiter in most instances is still a subtotal thyroidectomy after adequate preoperative preparation. However, the method of preoperative preparation has been modified. By the use of propylthiouracil or some other suitable antithyroid drug it is possible to reduce the basal metabolism to normal and eliminate the thyrotoxicosis before operative procedures are carried out. As a result, the risk of operation is no greater than in patients with nontoxic goiters.