-j=
Oz radioiodine tnerapy is to know srecisely the rac dose that
was reeivec zy, the
gianc. The important = 425tion is whether there is 4 just elevate dbse oz -"+I
wrecn will bring a hyperthyroid satient to a euthyroid State «itnout) uitiretealy
developing hypothyroid-==.. The cther question is whether ar iraces te aose o
-°--l is more inclined t= lead to nectlasm formation.
In 4 few cases, Mistslogic samples cf the gland have Leccome av llazle secause
surgery was indicated owing to the appearance of a mass or persist
2 or syperthyidism that required =satment. The procurement or tissue i= srov ing =0. sppor“umity to study the effects of the radiation in various arezs <f
glané sy autoraclography.
Thus, we continue <> follow cur radioiodine therapy cass= dili entiy witn re-
peated examinations tc i50k for the devélopment of masses anc <9 re ppraise thyroid
€.
M
function.
The Protiem of Selecting the Right Dose of
Treatment of Graves’ Disease
An
a dose of
radiated.
7
*"*2 fort
rtant variéi=le in trying to anticipate and estima es th
1211 is the s-ructural character of the particular zland
This is pre=Sebly as important as the weight or sics of
all of the volume may mst be attributable to thyroid cells - _rAisto
roids of Graves' disease may be quite variable. The gland ==;
trated with lymphocytes, in which case, it will be very five and
A considerable part of its volume may be blood and as a result it
effectiveness of
tis to be ir
e gland because
gicaliy the thyensively infil-
bery cm examinatio:
ill be very soft,
compressible and have = bruit. The gland may be involuted wich a
volume occupied by colisid. Such a gland is rather firm, bu= not
tensively infiltrated with lympocytes. This gland often feels ra
very hyperplastic glar<c with few lymphocytes or colloid is composed
ds firm as when expedsly. The
of reiatively more
of gland usually occirs in younger individuals.
gntrins-cs character-
cells.
Such a gland is quite vascular.
The history is of scort diratian.
We believe <hese
This type
istics of the gland <= Graves' disease play a major part ir. the effectiveness of the
radiation.
The greater the space occupied by lymphocytes, x=-_loidj
tissue the more ionize=ion is spent in these structures rater t
or connective
in the cells that
produce hormone. Such characteristics can only be inferrec =rom afimowlecge of the
pathology as it relates to the features of the physical exac=mati
Unfortunately a
biopsy of a large number of thyroids before
it therapy is z¢ven
not justifiable.
However, any physician or surgeon who devotes a great deal <== his
thyroids, judges and records the character or the giand at poysl
personally reviews the nistology on each gland that is oper=ced si
relate the findings wich reasonable accuracy.
Information = the
ter of the gland, alcmz with kinetic data on the behavior cr the
given individual shou. help unravel the explanation as to y th
kime te examining
examination and the
dose oF
+311 pro-
duces prompt hypothyrciaism in some patients and is relative_y in rfective in others.
In a similar manner tre surgeon .whc records his estimate oz ne w
Graves' disease from is preoperative physical examination =.3 th
amount of tissue he resoves and from that estimates the amo=t of
has performed a unique control on his preoperative estimate. Wit
refine his judgement c= thyroid weights for those to be trezced wi
ight of a thyroid ir
sees and weighs ti
tissue “nat remains
e
th
rience, he can
2