DISCUSSION 



Dr. Thomas: The actual difference if you see the complete data does not fall into 

 those groups. Some people who have a large dose do well and some people who have 

 small doses do well. That depends on the individual response of the patient to radia- 

 tion. Speaking generally, if a patient has a high iodide clearance rate he will require 

 a big dose, particularly if our previous experience has shown that he is resistant to 

 radiation. 



Mr. Tirrell: Is there any numerical relationship between the basal metabolic rate 

 over that period and the values given there, or does it fluctuate from patient to 

 patient? 



Dr. Thomas: Well the basal metabol'c rate if measured by a reliable technique would 

 correspond more with the clinical assessment of the patient, and that might still be 

 very high. We have had patients who are clearly very toxic in this period in which 

 we have a normal uptake rate, and we have stayed our hand and not given further 

 treatment then because we maintain that if the thyroid is sufficiently damaged at 

 that point not to be producing more thyroid hormone, the patient must eventually 

 catch up and that is in fact what happens. The basal metabolic rate at that early 

 stage would still be high, corresponding with the clinical status of the patient. 



247 



