PROBLEM CASES OF TOXIC DIFFUSE GOITER TREATED WITH RADIOACTIVE IODINE

Several investigators¹ have reported the successful use of radioactive iodine in the management of toxic diffuse goiter (Graves' disease). In the published reports, no particular emphasis has been given to this form of therapy in cases of hyperthyroidism in which complications exist due either to the underlying disease or to unrelated illnesses, and which therefore render surgical treatment an inadvisable or risky procedure. Surgical management of most cases of thyrotoxicosis has proved to be satisfactory, but in a few situations it carries a mortality risk or the danger of undesirable surgical complication or gives poor results. Among these surgically unsuitable situations are: (1) patients with multiple recurrences of thyrotoxicosis after previous adequate surgical removal of thyroid tissue, (2) patients with severe congestive heart failure, (3) patients with extreme emotional instability or frank psychosis and (4) patients with unusually severe toxicity difficult or impossible to control by antithyroid drugs or