Thiouracil in Toxic Goitre

Abstract

The widespread clinical trial of thiouracil and its derivatives in toxic goitre since 1943 has shown that they are very effective in reducing the excessive thyroid secretion of this condition. A partial answer can now be given to those questions which naturally arose as to the value of these antithyroid drugs compared with other methods of treatment. The first question was whether or not thyroid function would remain normal after the drug was discontinued, and how long it would be necessary to give the drug before it could be discontinued. Equally important were the nature and the frequency of toxic effects and how, if at all, they were to be avoided. Thirdly, were there any particular age groups or clinical types for which thiouracil was especially suitable or contraindicated ? The answers to these problems would of course decide the place of thiouracil in relation to other methods of treatment, thyroidectomy in particular.With regard to remissions, Beierwaltes and Sturgis (1946a) noted eight in 45 cases; the course of thiouracil had averaged 101 months in the eight cases, and the duration of the remission (to date) was from 3 to 12 months. Their cases of nodular goitre were not treated by thiouracil but by thyroidectomy. Himsworth et. al. (1947)

Thiouracil in Thyrotoxicosis

“…Out of Nussey's (1944) three patients sinus rhythm was restored by thiouracil in one. In a later paper Cookson and Staines (1947) (1946) reported reversion to sinus rhythm in five out of six cases included in the present series.…”

Thyrotoxic Auricular Fibrillation Treated with Thiouracil

“…Accordingly such cases were admitted as emergencies to the ward, digitalized on admission, and then given quinidine. In many cases, however, like the one here reported, the fibrillation may be allowed to continue and the heart failure will respond to thiouracil alone (Cookson and Staines, 1947).…”

“…Out of Nussey's (1944) three patients sinus rhythm was restored by thiouracil in one. In a later paper Cookson and Staines (1947) claimed reversion to sinus rhythm with thiouracil alone in eight out of 16 patients after an average of 35 days' treatment, the longest period being 15 weeks and the shortest four days. Associated cardiac disabilities (mitral stenosis) are reported in only one of the patients with persistent fibrillation, McGavack and others (1945) reported reversion to sinus rhythm with thiouracil alone in 12 out of 18 patients, one of the 12 having bundle-branch block.…”

THIOURACIL COMPOUNDS in the treatment of THYROTOXICOSIS

“…One reason for differences of opinion on the former issue has been the myth which has grown up that nodular goitre patients react less well to thiouracil than those with primary thyrotoxicosis. Wilson and Goodwin (1947) found that sueh was not the case, while Cookson (1947) obtained his best results in elderly patients and in young persons with a goitre of small or moderate size. Another reason lies in the undoubted fact that thiouracil may cause sufficient enlargement in a nodular goitre to produce obstructive phenomena, but careful observation should always lead the clinician to recognize this early, so that operation can then be advised.…”

“…The maximum incidence of toxic reactions with thiouracil compounds has been reported as I:) per cent. (Cookson, 1947;Bartels, 1948. ) Hims-Worth (194 8) considers that two-thirds of all.…”