The present study is a two year retrospective analysis of Graves' disease patients who presented to the AIIMS Endocrinology outpatient department during January 2002 to December 2003. Of 214 patients with Graves ' disease, 130 were females and 84 males. The average age at the onset of disease was 34.8 ± 11.9 years (11-70 years) and the average duration of the disease was 8.4 ± 6.5 months. Weight loss, palpitations, diaphoresis and tremulousness were the most common presenting complaints. A goitre of varying grades (Grade 1=32.6%, Grade 2=58.3%) was present in 85.2% of the patients. An infiltrative ophthalmopathy was present in 44 patients and pretibial myxedema was present in one patient. Of 214 patients, 15 patients were advised surgery, 42 patients were advised radiotherapy and rest were put on medical therapy. Patients with a minimum follow-up of four months on Carbimazole were included for analysis. The patients followed up for an average period of 8.6 ± 4.2 months at mean follow-up intervals of 2.7 ± 1.7 months. An initial euthyroid state could be achieved (82.9%) and maintained in a majority (75.6%) of patients. The average dose and duration to achieve euthyroidism was 30.05 ±0.8 mg and3.2 ±2.4 months respectively. Amongst 34patients who achieved euthyroidism, 19 patients were initiated on a 30 mg dose, 6 on a 20 mg dose and 5 patients were initiated on a 45 mg dose. The average duration to become euthyroid was similar (2.2 ±1.1, 3.5 ± 2.6 and 2.4 ±1.1 months respectively) with the three treatment doses used (p value=0.65). Conclusion- We conclude that medical therapy is an effective means to achieve and maintain euthyroidism. Low dose of Carbimazole is as effective as the higher dose in achieving euthyroidism.

The widespread use of fluoride to reduce dental caries has aroused considerable controversy. Fluoride is toxic when consumed in excessive amounts. Industrial fluorosis is on the increase on a global basis. While some researchers have concluded that fluoride has no effect on the thyroglobulin content of the thyroid gland or the degree of iodination of thyroglobulin, others have shown that adverse changes occur with higher intakes of drinking water in endemic fluorosis areas or with fluoride treatment.

Different types of composite tumors have been described in the thyroid. Of these, a combination of tall cell variant of papillary and Hurthle cell carcinoma is one of the commonest one. We describe a rare case of medullary -papillary carcinoma of thyroid.