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.

9/18 (page 9)

of treatment, and were accompanied by a transient rise of the B. M. R. After three or four days, however, he seemed to accommodate himself to the increased dose of iodide and the symptoms improved. At this stage we decided to omit the iodide altogether. The result was a further exaggeration of the symptoms and a rise in the B. M. R. The iodide was withheld for 16 days and then recommenced in doses of 2 gr. twice a day. The resumption of the iodide was followed by an improvement in his condition and a transient lowering of the B. M. R., but the latter soon rose again and settled down to a constant level of about + 50 per cent., where it remained for the next month, being unaffected by a reduction of the iodide from 4 gr. a to 2 gr. He had now been in hospital for four months ; he was still very nervous and excitable, his pulse was rapid and his heart tumultuous in its action. His weight had at one time been slowly rising, but for the last month had been steadily falling. His goitre, however, was diminishing in size ; the neck measurement had been 14-J in. on admission and was now only 13§ in. A remarkable improvement now began to take place. The B. M. R. and pulse-rate fell steadily and the weight increased. This improvement was watched for three months, during the whole of which time he was receiving 2 gr. of iodide a day. At the end of this time his B. M. R. was + 25 per cent., his resting pulse-rate 80, and he had gained 27 lb. Iodide had been given altogether for 37 weeks and it was now stopped, medicine not containing iodide being substituted to eliminate any possible effect of suggestion. For the first few days there was no change in his condition ; then he began to complain of palpitations and disturbed sleep, and his pulse-rate and B. M.R. rose. His weight, which had been rising steadily for three months, began to fall. The iodide was withheld for 13 days and then resumed. Its resumption was very soon followed by a marked improvement in the symptoms and a rise in weight. Within 10 days the B. M. R. had fallen to + 20 per cent, and a resting pulse of normal frequency was observed for the first time. Case III. Severe exophthalmic goitre. History. M. H., a single girl of 19, had * always had rather a big neck but took no notice of it till two years before admission to hospital, when it increased in size and she consulted her doctor about it. She felt quite well at this time and paid no further attention to the swelling of her neck till 18 months later, when she began to get short of breath and to suffer from frequent headaches. She then received a course of X-ray treatment which she states did not do her very much good. She had spent a month in bed shortly before coming into hospital, and had recently had a bout of vomiting which lasted a week. Condition on admission. She was poorly nourished and very restless and excitable. She perspired freely and flushed deeply at the slightest provocation. She had pronounced exophthalmos with a well-marked von Graefe’s sign. The thyroid was very considerably enlarged but was not pulsating: the swelling was uniform and of firm consistence. The heart’s apex-beat was displaced somewhat to the left. The pulse-rate was 140, the rhythm was regular, and its wave was distinctly of the collapsing type. There was no rhythmic tremor of the hands, although coarse jerky movements were apparent in the arms when an attempt was made to hold them out steadily. Treatment. 2 gr. of potassium iodide were given twice a day after she had been under observation for a week. This dose was continued for two months and then reduced to 1 gr. twice a day. Six weeks later the drug wTas stopped altogether, but wras resumed after eight days and kept on till her discharge. Progress. It will be seen from the chart (Fig. 4) that the B. M. R. and resting pulse-rate were very considerably raised during the 10 days immediately follow¬ ing her admission. They showed a sudden fall 8 days after the iodide was begun, the pulse-rate dropping from 120 to 90 and the B. M. R. from + 65 per cent.