Of a group of 55 thyrotoxic patients given therapeutic radio-iodine (131I), 24 were made euthyroid with carbimazole before 131I: the remainder were given 131I alone. Carbimazole was discontinued 5 days before 131I was administered. By 3 months after 131I treatment there was a greater incidence of hypothyroidism in the group given 131I alone (42% vs 25%), but a lower incidence of persistent thyrotoxicosis (16% vs 46%), (P less than 0.05). One year after treatment a similar proportion of each group had persistent thyrotoxicosis (21% vs 23%), but there remained a lower incidence of hypothyroidism in the group pretreated with carbimazole (25% vs 45%). It is suggested that pretreatment with carbimazole reduces the degree of radiation induced thyroid damage.

Abstract. In spite of the long-established use of antithyroid drugs, there are many unsettled questions connected with this treatment of Graves' disease. There is a lack of controlled prospective trials studying the results of antithyroid drug therapy while considering the many variables such as disease heterogeneity, regional differences, drug dosage and duration of treatment. Therefore, a multicenter study has been set up in order to compare the effects of two fixed doses of methimazole (10 vs 40 mg) with thyroid hormone supplementation on the clinical, biochemical and immunological course of Graves' disease and on remission rates. Experience accumulated so far suggests that treatment is safe using either 10 or 40 mg of methimazole. While there is a tendency for an advantage of the higher dose within the first weeks (higher effectiveness in controlling hyperthyroidism), this difference is not significant. The impact of dosage on remission rates remains to be shown.

No abstract

Summary Biopsies of clinically normal skin of 22 young patients with insulin‐dependent diabetes of varying duration (> 10 years, n < 5 years, n= 10) were examined using a panel of histological stains, and compared with those of 10 non‐diabetic control subjects of similar age. Abnormalities under light microscopy were scored for severity. Scores for both groups of diabetics were significantly greater than scores for controls (P < 0·001). Increased upper dermal vasculature and PAS posttivity of blood vessel walls were more frequent in diabetic skin than in controls, and increased with duration of disease. PAS positivity was caused in part by deposition of glyeogen in cndotheiinl cells. Clumping of elastic fibres in the upper dermis was observed in seven of the 22 skin biopsies from diabetic patients, but not in control biopsies. An inflammatory infiltrate was more frequent in diabetic skin. No association was demonstrated between the histological scores and the presence of diabetic retinopathy, or the concentration of glycosylated haemoglobin in the diabetic subjects. None of the histological features was specific to diabetic skin.

A prospective study of thyroid function including serial tracer radioisotope uptake measurements in 55 patients treated with 131I therapy is described. Five patients had an episode of transient hypothyroidism within eight months of treatment: in three of these patients this was due to impaired organification of iodide, with normal iodide trapping by the thyroid (as measured by a twenty minute 123I uptake) being preserved. In contrast, in all patients who developed permanent hypothyroidism, iodide trapping was markedly diminished and did not recover. It is suggested that hypothyroidism due to organification failure following 131I therapy is potentially short-lived; where hypothyroidism is associated with gross impairment of iodide trapping, recovery is unlikely. Early iodine uptake measurements may be of value in selecting those patients whose hypothyroidism is transient and who do not require permanent thyroid hormone replacement.