Douglas Biggs, MD, Senior Assistant Resident in Medicine, Jewish Hospital of St Louis, Assistant in Medicine, Washington University School of Medicine: A 19-year-old woman was admitted to Jewish Hospital for thyroid surgery in August 1974. In April 1973, she was examined because of excessive weight loss and fatigue. The thyroid gland was enlarged diffusely five to six times; a Murphy-Patte T4 level was greater than 20μg/100 ml, and a six-hour sodiumiodide I 131 thyroid uptake was greater than 60%. The scan showed a diffusely enlarged gland, without nodules. Therapy with propylthiouracil, 100 mg four times a day, was started at that time. The dose of propylthiouracil was gradually increased during the next year, but the clinical response was less than adequate. In June 1974, the dosage of propylthiouracil was increased to 400 mg four times a day. After two months on this dosage regimen, the patient remained hyperthyroid clinically,
Haibach H, Avioli LV. Hyperthyroidism in Graves DiseaseCurrent Trends in Management and Diagnosis. Arch Intern Med. 1976;136(6):725–731. doi:10.1001/archinte.1976.03630060077016
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