The effect of iodine on hyperthyroidism in man / by S.J. Cowell and E. Mellanby.

  • Cowell, S. J. (Stuart Jasper)
Date:
[1924?]
Catalogue details

Licence: In copyright

Credit: The effect of iodine on hyperthyroidism in man / by S.J. Cowell and E. Mellanby. Source: Wellcome Collection.

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    she was under observation the measurements fluctuated between + 94 per cent, and + 56 per cent. After this she began to show definite signs of improvement, and although the B. M. R. kept steady at the high level of + 67 per cent., her weight slowly increased. The potassium iodide was started when the B. M. R. appeared to be more or less constant. There was no apparent effect on either the B. M. R. or pulse-rate for the first twelve days of its administration. There was then a fall in the B. M. R. of nearly 30 per cent., while the resting pulse-rate fell from 126 to 106. The fall in the B. M. R. was continued for a week, and a gradual rise then took place, so that on her discharge from hospital the B. M.R. was +45 per cent. (Fig. 9). During the ten weeks of treatment outlined above she gained 20 lb. in weight and lost much of her excessive nervousness. Her pulse-rate remained high, although she could take mild exercise without causing herself any distress. It is interesting to note that the circumference of her neck increased out of proportion to her general increase of flesh, and her thyroid could be very readily felt when she left hospital. Discussion of results. In every case of hyperthyroidism that we have observed up to the present time the giving of small doses of iodide has resulted in a distinct clinical improvement. This improvement becomes obvious at the end of a week, and as regards slowing of the pulse-rate, lowering of the B. M. R., and lessening of the general nervous excitability, attains a maximum between the tenth and the twentieth days of the treatment. From this time onwards we have observed considerable variation in the response of different patients. (1) They may remain for several weeks in this improved condition, with a low B. M. R. and slow resting pulse-rate, and then develop a slight and gradual return of the symptoms. (2) There may be a rather sudden return of the symptoms soon after their maximum decline, the patients continuing to put on weight and regain strength in spite of an increased metabolism and tachycardia. These two classes comprise the bulk of the patients that we have observed. (3) Occasionally there may be a more violent exacerbation in which the symptoms return within the course of a week or two to their original degree of severity. A striking example of this type of response was obtained in a patient whose case has not been detailed above. She had a large adenomatous thyroid of long standing with severe toxic symptoms. After four days of iodide treatment her B. M. R. fell from + 55 per cent, to + 8 per cent, with corresponding clinical improvement. The B. M. R. remained at this level for a fortnight and then rose quickly to its former level. We are not able to predict with any certainty what course is likely to be followed by any particular case. It would appear, however, that those patients with large hard glands are more likely to develop severe * reaction3 symptoms than those with smaller soft ones. The amount of iodide given does not appear, within certain limits, to control the rate of improvement noted in the early stages of treatment. Thus the giving of nine grains of potassium iodide a day has been followed by the same
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