It is probable that no patient is wholly refractory to these drugs. Failure to respond is likely to be due to the patient not taking the tablets or to wrong diagnosis. The drugs are used in hyperthyroidism as

• principal therapy,

• adjuvant to radioiodine to control the disease until the radiation achieves its effect,1

• to prepare patients for surgery.

Clinical improvement is noticeable in 2-4 weeks, and the patient should be euthyroid in 4-6 weeks. The best guides to therapy are the patient's symptoms (decreased nervousness and palpitations), increased strength and weight gain, and pulse rate.

Symptoms and signs are, of course, less valuable as guides if the patient is also taking a P-adrenoceptor blocker, and reliance is then put on biochemical tests.

With optimal treatment the gland decreases in size, but overtreatment leading to low hormone concentrations in the blood activates the pituitary feedback system, inducing TSH secretion and goitre.

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