ne problem of selecting the right dose has been approached.
—
It is] well known that
the histological structure of glands that cause hyperthyroidism is htuite variable.
That variability appears to have considerable bearing on the effectiveness of the size
of the dose of 131, required.
Although we have not resorted to biopsy before treat-
ment is given, much has been gained from reviewing the histologic
features of all glar
thoroughly studied and characterized before surgery and then by usihg those clinical
features (hardness, softness, lobulation, nodularity, bruit, etc.)
[to estimate the
Structural character of the particular gland that is to be irradiated.
This has
appeared to be as important as the weight or size of the gland because much of the
volume may not be composed of thyroid cells. With the limited rangq
of the beta ray
within the thyroid gland,ionization may take place in structures distributed among
thyroid cells.
roid cell.
Thus, the ionizing effect may take place at sites
qther than the thy-
The gland may be extensively infiltrated with lymphocyfes, in which case,
it will be more firm and rubbery on examination.
In contrast a comsiderable part of
its volume may be blood and as a result it will be very soft, compyessible and have a
bruit.
The gland may have become lobulated and thus involuted wit
a considerable
part of its volume occupied by colloid with only spotty areas of hyperplasia.
from the radioautographs that the 13 ly is then taken up in a very
We knc
ottled pattern.
Such a gland is lobulated and rather fim, but not as firm as when|infiltrated with
lymphocytes.
This gland often feels rather pebbly.
The very hypefplastic gland witt
few if any lymphocytes or colloid is composed of relatively more cRlls.
Servations, we believe these intrinsic characteristics of the glanf
play a major part in the effectiveness of the radiation.
pied by lymphocytes,
From our ob-
of Grave's disea:
The greafer the space occu
colloid, or connective tissue the more ionizBtion is spent in
these structures rather than in the cells that produce hormone.
Spch characteristic:
can only be inferred from a knowledge of the pathology as it relatks to the features
of the physical examination.
However, any physician or surgeon whp
devotes a great