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To the Editor.—
Thomason and Nusynowitz (242:2437, 1979) in an editorial, "Thionamides for Hyperthyroidism: On a Clear Day You Can Treat Forever," admirably summarized the risks and advantages of drug treatment for hyperthyroidism.Inasmuch as the effects of iodine 131 therapy and surgery are relatively permanent, the clinician must be cautious in recommending such therapies in the presence of exophthalmos. Occasionally, the eye manifestations of Graves' disease may worsen during or after control of the primary thyroid problem.I advise thionamide therapy for patients with exophthalmos because, by using medication, the physician can closely regulate treatment. If a patient's eyes worsen during thionamide administration, appropriate options—such as dose reduction or use of steroids—can be used without the physician being committed to a single irreversible course of therapy.On the other hand, if after two to three months of treatment, the exophthalmos is stable or regressing, definite treatment may be considered.By
Gott PH. Treatment of Graves' Disease. JAMA. 1980;244(14):1558. doi:10.1001/jama.1980.03310140018010