No abstract

Eighteen patients with ocular manifestations of Graves' disease were treated by plasma exchange. Detailed clinical, ophthalmological and orthoptic assessments were made including computerized axial tomography and A + B scan ultrasound of the orbits. Seventeen different ocular parameters were separately rated for each patient. The changes recorded were small, statistically insignificant, and no patient was cured of ocular disease. There were no significant correlations between the ocular changes recorded and age, sex, duration of ophthalmic symptoms, the presence of thyroid antibodies, the number of exchanges, or the concurrent administration of azathioprine.

Twenty-one patients with hyperthyroid Graves' disease were treated with carbimazole 30 mg daily, given as a single dose. Propranolol was also given for the first 3 weeks. All became clinically euthyroid with normal serum thyroxine (T4) levels, usually within 1-3 months. Patients with large goitres and raised serum alkaline phosphatase concentrations took longer to respond. In 19 patients a positive thyroid stimulating hormone (TSH) response to intravenous thyrotrophin releasing hormone (TRH) developed. Carbimazole was stopped soon after (median time of treatment 18 weeks, range 9-41 weeks) and 18 patients have been followed. Seven of these (39%) have remained in remission from hyperthyroidism for more than one year (median 77 weeks). Carbimazole 30 mg once daily is a convenient and effective treatment for hyperthyroid Graves' disease. Many patients will achieve prolonged remissions if treatment is stopped when serum T3 and T4 levels are in the low-normal range, usually 2-4 months after clinical euthyroidism has been reached.

The large number of recent publications concerning the inter-relationships between the central nervous system and the anterior pituitary testifies to the intense interest in this subject (2, 3). Particular attention has been devoted to the effects of hypothalamic stimulation or injury upon pituitary ACTH release and adrenal cortical response. The work of deGroot and Harris (4), Hume and