Sporadic Non-Toxic Goitre

Abstract

Thirty-six patients with non-toxic goitre were reviewed after a mean period of 13 years. Initially 19 patients were iodine deficient (Group I) and 17 had normal plasma inorganic iodine (Group II). In general the iodine deficient patients had larger goitres, developed more complications (26 % became hyperthyroid, hypothyroid or required partial thyroidectomy), and required more treatment. There were marked changes in thyroid function tests. In both groups thyroid uptake fell and PII rose though the final PII remained significantly lower in Group I patients. Thyroid and renal iodide clearance fell significantly in Group I patients only. In both groups the final mean total serum T3 levels were abnormally elevated whereas the mean PBI levels did not change significantly during the period of study and the final mean total T4 concentrations were normal.All goitres became smaller and there were no complications in patients whose goitre became impalpable. No cases of malignancy and no postoperative recurrences of goitre were observed. It is suggested that the incidence of complications in those patients who persist with palpable goitres is sufficient to merit follow-up of this group.

A Conservative Approach Is Reasonable in Patients with Non-Toxic Goitre: Results from an Observational Study during 30 Years

“…This value can be compared with an annual incidence between 4.3 and 18.2 in four relatively small series of goitre populations [8,10,17,18] and the finding of 4.7 new cases per 1,000 patients per year in the present investigation of a large goitre population followed for a long period of time. Evidently, the goitre patient has an increased risk of developing thyrotoxicosis in comparison to the normal population.…”

“…There are some scattered reports on the change in functional status and the risk of thyroid cancer in longstanding nodular goitre but the number of patients is small and they are not adequately followed up in some of these studies [8,9,10,14,15,16,17,18,19]. Thus, the true incidence of hormonal dysfunction, cancer development and the need of surgery in the goitre population is not known, nor if generous indications for surgery are more cost-effective than expectancy in the long run.…”

“…The natural history of goitre has been studied with palpation [8,9] or ultrasonography [10,11,12] with highly variable results. While some studies indicate that many goitres seem to diminish with time [8,9], other studies claim that most nodules grow slowly but continuously with time [10,11] or stay stable, at least during a follow-up time of 40 months [12].…”

“…While some studies indicate that many goitres seem to diminish with time [8,9], other studies claim that most nodules grow slowly but continuously with time [10,11] or stay stable, at least during a follow-up time of 40 months [12]. Nevertheless, clinical observations suggest that only a minority of goitre patients seek medical advice during a lifetime indicating that the moderately enlarged thyroid gland gives comparatively few symptoms.…”