Single Daily Dose Methimazole Treatment of Hyperthyroidism

The effectiveness of methimazole used in a single daily dose was studied in 47 patients during their initial episode of hyperthyroidism, and in an additional eight patients during a relapse of hyperthyroidism. All patients become euthyroid using this method. Mean time required to achieve a euthyroid state was 16.7±1.1 weeks in the former group, and 14.9±2.9 weeks in the latter. In one patient there was an initial response to single daily dose therapy, but subsequently split dosage was required for control. The single daily dose regimen of antithyroid drugs will control hyperthyroidism in most patients. We have found that propylthiouracil will achieve this more rapidly than methimazole.     

Immunoreactive Corticotrophin Levels in Adrenocortical Insufficiency

Plasma concentrations of immunoreactive corticotrophin (ACTH) have been determined in 14 patients with untreated Addison''s disease and in 42 patients with secondary adrenocortical insufficiency. Basal morning plasma ACTH levels were markedly raised in those with Addison''s disease but were either in the normal range or undetectable in the group with secondary adrenocortical insufficiency. In the group with Addison''s disease circulating ACTH values showed a definite nyctohemeral rhythm, a pronounced rise in response to insulin-induced hypoglycaemia, and an immediate fall following the intravenous injection of corticosteroids, with a half-life of between 13·5 and 44·2 minutes. When assays were performed with antisera directed against the portion of the ACTH molecule responsible for corticosteroidogenesis (the N-terminal portion) the apparent ACTH concentrations were lower than with antisera directed against the non-steroidogenic (C-terminal) portion of the molecule. This emphasizes that different antisera may give different apparent hormone concentrations, and that the ranges of values obtained in normal and abnormal states must be established for each antiserum.     

Comparison of Corticotrophin and Prednisolone in Treatment of Idiopathic Facial Paralysis (Bell's Palsy)

In a controlled trial of the effects of intramuscular corticotrophin and oral prednisolone in the treatment of acute Bell''s palsy 186 successive patients with idiopathic facial palsy were grouped for age and duration of palsy. They were then allocated at random to either corticotrophin or prednisolone therapy in pairs. The results were:(1) 94 received corticotrophin and 32 developed some degree of denervation and 92 received prednisolone and 13 developed some degree of denervation (P <0·005); (2) six of the corticotrophin group became severely denervated (less than 50% recovery) compared with none of the prednisolone group (P <0·02); (3) the best results were obtained in the younger patients (less than 45 years old) treated on the first or second day of palsy; and (4) side effects were minimal.It is concluded that oral prednisolone is the treatment of choice for idiopathic facial (Bell''s) palsy.