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To the Editor:—
In answering the question regarding juvenile hyperthyroidism and malignant exophthalmos (JAMA192:927 [June 7] 1965) I would suggest a more conservative approach than is recommended by the consultant.Progression in the exophthalmos in spite of an achieved euthyroid state forebodes worsening of the exophthalmos, particularly following radical therapy. Conservation of thyroid function is indicated for its braking effect on the anterior lobe of the pituitary gland.As an initial step, I would gradually reduce and eliminate the prednisone since it no longer serves a useful purpose. At the same time, the doses of methimazole should be reduced by 6 mg every eight hours at weekly intervals until it too has been discontinued. The sodium levothyroxine may then be increased gradually by 0.05 mg daily up to 0.2 mg daily as long as euthyroidism continues. Should hyperthyroidism recur, remission may be readily achieved with small 5-to 10-mg
Reveno WS. Conservative Therapy of Juvenile Hyperthyroidism. JAMA. 1965;193(9):746. doi:10.1001/jama.1965.03090090052029