Edward Wayne

Effect of Pretreatment with Methylthiouracil on Results of 131I Therapy

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Association of Thyrotoxicosis and Auto-immune Thyroiditis

Roitt and Doniach (1958) have demonstrated that circulating thyroid auto-antibodies are present in a large proportion of patients with auto-immune thyroiditis (Hashimotos disease). In this paper we show that the application of these immunological tests in patients with symptoms suggestive of thyrotoxicosis is of considerable practical importance, since we have been able to identify two groups in which the correct diagnosis could not otherwise have been made and where mismanagement might have occurred. In the first group evidence of auto-immune thyroiditis was found in patients with undoubted thyrotoxicosis. Only one fully documented case of this association has been previously described (Doniach and Hudson, 1959; Doniach et al., 1960). We were also able to define a second group of patients who had been referred to the clinic because of suspected thyrotoxicosis and in whom radioiodine tests had appeared to confirm this diagnosis. Further investigations, however, showed that these patients were in fact euthyroid and that the presence of auto-immune thyroiditis explained the abnormal laboratory findings.

The changing face of medicine

The introduction of automation and the computer will profoundly affect all branches of medical practice. Already the computer can help in the routine diagnosis of thyroid disease, and its use has emphasized the necessity of allowing for observer variation, for example when eliciting physical signs or interpreting radiographs. It may eventually be possible to reduce variability by automation. The relative ease with which multifactorial analysis can be carried out has altered the approach to the design of research projects. Hospital records can now be analysed by computer and can give a measure of the relative efficiency of different units and of different hospitals. These changes will affect the type of medical education required for all branches of the profession.