We investigated whether thyrotoxic patients treated with short-term antithyroid therapy would achieve prolonged remissions. Thirty-one previously untreated and nine previously treated patients with thyrotoxic Graves's disease received a single daily dose of methimazole or propylthiouracil. The drug was stopped at, or shortly after, the time they became euthyroid. Twelve of the 31 previously untreated patients remained in remission for 29 +/- 3.5 months (mean +/- S.E.) after treatment for 4.5 +/- 0.3 months. Four of the nine previously treated have remained in remission of 13.0 +/- 2.1 months after treatment for 3.0 +/- 0.3 months. Of various possibilities analyzed, only a small goiter at the onset of therapy and tri-iodothyronine toxicosis were significantly favorable prognostic indicators that a remission would be maintained. The lasting remission rate is as good when antithyroid drugs are stopped as soon as the patient is euthyroid as when they are continued for one year or more.

We have treated 68 thyrotoxic patients with Graves' disease with a single daily dose of 30 mg methimazole until they were clinically euthyroid and their plasma thyroid hormone concentrations were within normal limits. Sixteen of 56 patients (29%) treated 4.8 +/- 0.2 months (mean +/- SEM; range, 1.5-8.5 for their initial attack of thyrotoxicosis have remained in remission for 54.4 +/- 7.7 months (range, 12-105). Twenty-seven of the patients who relapsed were treated with a subsequent 1-yr course of methimazole. Five of these patients (19%) have maintained a remission for 29.6 +/- 10.8 months (range, 3-66); the remainder relapsed after 7.1 +/- 2.3 months (range, 1-50). If the patients lost to follow-up while known to still be in remission are excluded, the sustained remission rate is 12 of 52 (23%) for initial short term therapy and 3 of 25 (12%) for the subsequent 1-yr of antithyroid treatment. The results of short term antithyroid drug treatment in 12 patients previously treated with long term antithyroid drugs or thyroidectomy were similar, but the follow-up period was not as long. Short term antithyroid drug therapy is a potentially long lasting, innocuous, and relatively inexpensive program for the treatment of Graves' disease, especially for patients with small goiters.

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A total of 54 patients underwent surgical exploration for primary hyperparathyroidism from 1980 to 1988. Beginning in November 1984 nearly all patients were evaluated with preoperative radionuclide and ultrasound imaging studies. Ultrasound correctly localized 76% of the adenomas removed at surgery, whereas the success rate with radionuclide imaging was 74%. Localization of hyperplastic glands was less successful with the use of either technique. Correct preoperative localization studies in cases of single adenoma reduced the operative time an average of 32 minutes when compared with those cases with no localization studies. Cost-effectiveness was studied based on current charges for operating room time, anesthesia, and the preoperative localization studies. An average cost savings of $124 per case was achieved when results of both localization studies were correct. These localization studies are quick, noninvasive, relatively inexpensive, and associated with no morbidity. Because it is possible to reduce operative time and overall costs, we recommend that radionuclide and ultrasound studies be routinely used in patients with primary hyperparathyroidism.

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