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By David G. Ferriman

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Antibiotics as prophylaxis against pneumonia. —Poor, even with skilled management. —Two forms of hyperthyroidism can be distinguished :— 1. —Many, if not all, cases of toxic diffuse goitre are thought to be due to the presence in serum of an abnormal substance known as long-acting thyroid stimulator (LATS). This is believed to be an auto-immune antibody produced by the reticulo-endothelial system. It is found in the serum y-globulin fraction. It has not been isolated from human pituitaries of either normal subjects or patients with thyrotoxicosis, but has been found in the sera of patients developing hyperthyroidism after hypophysectomy.

Surgery is hazardous and antithyroid drugs have to be given in doses which may produce agranulocytosis. Choice therefore lies with 131 I therapy; 25 mc. are given, followed later by thyroxine in doses calculated to give maximal relief from angina with minimal hypothyroidism (average dose 0-05 mg. per day). Treatment is effective in a proportion of cases, but it should be reserved for severe cases not achieving sufficient relief from other methods. , are situated in apposition to the upper poles of the kidneys at the level of the first lumbar vertebra.

Hypotension, croaky voice, muscular rigidity. Extensor plantar reflexes. G. changes: prolonged QRS, inverted T waves, J wave at junction of QRS and S-T segments in chest leads. — 1. Cover with blanket and nurse in warm room. Active rewarming is dangerous. 2. Tri-iodothyronine is given for rapid effect but in small doses (5 μg. intravenously at 8-hour intervals). Cardiac muscle is affected by myxoedematous change and indirectly by grossly atheromatous coronary arteries. Larger doses of T3 may precipitate acute cardiac failure and death.

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