Geneesheer-Directeur St. Elisabeth’s of Groote Gasthuis te Haarlem?

C. A. Graafland, Rontgenbestraling van de schildklier en strumectornie bij thyreotoxicose. Acad. proefschrift. Leiden Oct. N. V. LEITER—NI.JPELS. Maastricht.
Uit dit lezenswaardige proefschrift blijkt, dat de strijd tusschen de röntgenologische en chirurgische behandeling van de thyreotoxicoses nog altijd niet is beslist.
In de Leidsche cliniek werden uitstekende resultaten verkregen met Röntgenbestraling, ook in. zware gevallen van de ziekte van BASEDOW. Het definitieve genezingspercentage was ongeveer even groot als bij de chirurgische behandeling. Een nadeel van de bestraling blijft de zeer lange duur dezer behandeling (gemiddeld 101/2 maand).
P. FORMIJNE

abstract
After an introductory article on Röntgentherapeutics of thyrotoxicosis, a survey is given of a test-examination of patients from the Leyden clinic and policlinic.
From Sept. 1st 1931 till 31st August 1937 125 patients were x-rayed and 67 operated on, 74 and 44 of both groups were summoned for a test and examined after 1940.
From these groups of patients 35% could not be reached or refused to turn up for this test-examination, About 45% of the total number of patients from both groups were cured. Sometimes a hypertension remained with them or many had nervous complaints without an increase of the B. M. R.
Of the patrents examined 60 to 70% appeared to he cured through x-ray treatment as weIl as through operation. About 10% of the x-rayed patients were operated on afterwards.
In about 12% of these cases a hypothyroidism developed after the operation both with and without complaints.
The chance of recovery by x-ray treatment of serious and moderately serious patients was greater than of the lighter cases. During the test-examinations of the lighter thyrotoxicosis-cases nervous complaints were fairly often heard.
The time tor recovery by Röntgen-treatment ran to about ten months on an average, although a very large majority reached a normal B. M. R. within six months time, the total invalidity, however lasting much shorter. Four to five series were given on an average. The more serious the disease the more series were given.There was a fair decline of the symptoms through x-ray treatment and operation.
The exophthalmus disappeared in 50% of the cases through both therapeutic treatments, it remained in one fourth of the cases. There existed in this respect no clear difference between Röntgenological and surgical therapeutics.
Also the goitre disappeared in about 50% of the cases through x-ray treatment.
In about 10% of the cases (both after x-ray treatment and operation it was discovered during the test-examination tlhat a hypertension had arisen. As a possible cause we may mention the patient's growing older, the dropping of the ovary and a hypophyseal, diencephalic affection. The hypertension often appeared to be combined wlth a very strong rise in the paltient's weight.
Only rarely oould a definite meaning be attached to the climacteric (that is to say, measured according to the definite stopping of the menstruation) for the rise of thyrotoxicosis; often an amenorrhoe during the illness again disappeared and the patient often menstruated quite normally again for years after the recovery.
The heart too and the further vascular system proved to have reacted favourably both through x-ray therapeutics and thyroidectomies. No essential difference was found between the two therapeutic methods. A clinically definitely noticeable damage done to the heart with the x-rayed patients was not to be found.
Röntgentherapeutics do not involve any danger, if well applied. Complications do not arise.
A possilble operation later on if necessary upon x-rayed patients did not offer any serious difficulties in the Leyden general hospital.

The following indications and directions are proposed:
1) Absolute indications for surgical therapeUtics:
a) patients with serious trachea symptoms;
b) the definitely chronic cases of thyrotoxicosis;
c) toxic noduair goiter;
d) progressive development of the disease in spite of x-ray treatment with further therapeutics;
e) cases attende by serious heart-symptoms;
f) serious other visceral affections.
2) Absolute indications for Röntgen therapeutics:
a) when patient refuses operation;
b) in case of urgent contra-indication against operation (a.o. when patient is refractory against iodine);
c) postsurgical relapses.
In the remainder of the cases one is justified in proposing x-ray therapeutics. Under very careful supervision of the general condition, B. M. R. and weight, the patient should be x-rayed in series, until the B. M. R. amounts to about 10 to 20%. A good collaboration between the internist and the Röntgentherapeutist is essential.
It is not right, once the diagnosis is made to continue only with purely internal therapeutics. In these cases the treatment must be combined with x-ray treatment.
At the commiencement bed-rest should be prescribed (2 to 3 months) , after that the patient can gradually be mobilised. After about 6 months the usual work can be resumed. This rule can be deviated from according to the gravity of the disease and the development through treatment.
Psychic conflicts should be solved, if possible, sometimes removal from home surroundings is necessary.
In a specifrc case the seriousness of a case at a girven moment need in itself not be a contra-indication against x-ray treatment.
Social indications in favour of and contra-indications against x-ray treatment should be carefully taken into consideration.