A long‐term follow‐up study of patients with non‐toxic diffuse goitre in Japan

Abstract

Summary OBJECTIVE Although non‐toxic diffuse goitre is a common disorder, little is known of the clinical course of patients. We therefore decided to investigate the long‐term clinical outcome of patients with non‐toxic diffuse goitre. DESIGN A retrospective study. PATIENTS Of 850 patients with non‐toxic diffuse goitre who met our criteria and were seen in our thyroid clinic between 1977 and 1985, 108 who had been followed for from 5 to 14 years (mean 8 years) were entered in this study. All patients fulfilled our criteria having soft diffuse goitres, normal serum TSH and T4 concentrations, and undetectable antithyroglobulin and antithyroid microsomal antibodies. MEASUREMENTS A family history of thyroid disease was obtained and the occurrence of Graves' ophthalmopathy was noted. Serum TSH and T4 concentrations, and antithyroglobulin and antithyroid microsomal antibodies were measured during the follow‐up period. Thyroidal radioactive iodine uptake (RAIU), serum free T4 and free T3 concentrations, and TSH binding inhibitory immunoglobulin (TBII) activities were determined in all patients who were subsequently found to have abnormal serum TSH or T4 concentrations or signs of Graves' ophthalmopathy. RESULTS Thirty‐six of the 108 patients (33%) had a family history of autoimmune thyroid disease. Elevated serum T4 or free T4 concentrations and depressed serum TSH concentrations were found in six patients during the follow‐up period. Hyperthyroid Graves' disease was diagnosed in four of the six patients, subacute thyroiditis in one, and transient post‐partum thyrotoxicosis in one. Hypothyroidism was found in one patient who was diagnosed as having transient post‐partum hypothyroidism. Euthyroid Graves' disease was diagnosed in one patient. Furthermore, six of these eight patients had a family history of autoimmune thyroid disease in first‐degree relatives. CONCLUSION During a prolonged follow‐up period of patients with non‐toxic diffuse goitre, Graves' disease was found in five of 108 patients (four hyperthyroid Graves' and one euthyroid Graves'), post‐partum thyroid dysfunction in two, and subacute thyroiditis in one. Six of these eight patients had a family history of autoimmune thyroid disease in first‐degree relatives. Long‐term follow‐up is necessary for patients with non‐toxic diffuse goitre, especially those who have a family history of autoimmune thyroid disease.

The incidence of thyroid disorders in the community: a twenty‐year follow‐up of the Whickham Survey

“…In a twenty-year follow-up of a sample of a south-western United States population aged 11-18 years, spontaneous regression by the age of 30 years occurred in 60% of subjects who initially had diffuse goitres (Rallison et al, 1991). In contrast, a retrospective study of a selected clinic population in Japan, found that diffuse goitres disappeared in only 5% of a subsample of 108 subjects after eight years of follow-up, and 7% of these subjects with goitre developed thyroid dysfunction (Hara et al, 1993). The current study has shown that the presence of a 'simple' goitre is not predictive of any biochemical or clinical evidence of thyroid dysfunction over twenty years.…”

“…In other shorter longitudinal studies, one-third of subjects initially anti-thyroid antibody positive in a population survey no longer had detectable antibodies 6 years later (Hawkins et al, 1980), whereas a five-year follow-up study of a sample of healthy elderly people aged over 70 years found that, despite significant fluctuations in antibody titre, all 51 subjects who were originally anti-thyroid antibody positive remained positive at follow-up (Lazarus et al, 1984). Incidence rates for hyperthyroidism in the community from large population studies average 0*1/1000/year in men and 0.4/1000( year in women, but the age-specific incidence varies considerably (Furszyfer ef al., 1970;Mogensen & Green, 1980;Barker & Phillips, 1984;Haraldsson et al, 1985;Berglund et al, 1990). The peak age-specific incidence of Graves' disease was between 20 and 49 years in two studies (Furszyfer et al, 1970;Mogensen & Green, 1980), but increased with age in Iceland (Haraldsson et al, 1985) and peaked at 60-69 years in Malmo (Berglund et al, 1990).…”

“…Incidence rates for hyperthyroidism in the community from large population studies average 0*1/1000/year in men and 0.4/1000( year in women, but the age-specific incidence varies considerably (Furszyfer ef al., 1970;Mogensen & Green, 1980;Barker & Phillips, 1984;Haraldsson et al, 1985;Berglund et al, 1990). The peak age-specific incidence of Graves' disease was between 20 and 49 years in two studies (Furszyfer et al, 1970;Mogensen & Green, 1980), but increased with age in Iceland (Haraldsson et al, 1985) and peaked at 60-69 years in Malmo (Berglund et al, 1990). The difference in mean incidence rates in women between these studies and the current study would suggest that many cases of hyperthyroidism may remain undiagnosed in the community if routine testing is not undertaken.…”