PubMed · 5997013
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H Steiner. 1966-06-03. [Surgical viewpoints].. https://pubmed.ncbi.nlm.nih.gov/5997013/
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To determine what and how many test items are necessary for the initial tests of examining patients with thyroid disorders, a questionnaire was sent to the council members of the Japan Thyroid Association. The thyroid disorders were divided into 4 categories; hyperthyroidism, hypothyroidism, diffuse goiter and nodular goiter. The questionnaire was constructed to ask for; 1) items routinely ordered at the initial examination, 2) items at least necessary among them, 3) the 5 most important items in the order, and 4) selection of only 2 items at most. Finally 112 answers were collected and analyzed. When only 2 items were allowed, they selected TSH and fT4 commonly among hyperthyroidism, hypothyroidism and diffuse goiter, indicating 2 items to be insufficient for differentiation of disorders. While in the case of nodular goiter, ultrasonogram and fine aspiration needle biopsy were selected. The number of routinely ordered items were from 6.62 +/- 2.00 (s.d.) (hypothyroidism) to 8.06 +/- 2.48 (nodular goiter), but much fewer items were chosen to be necessary at least. In hyperthyroidism 4.56 +/- 1.92 items were required, in hypothyroidism 4.39 +/- 1.92, in diffuse goiter 4.93 +/- 1.75, and in nodular goiter 5.15 +/- 2.13, respectively. Most of the function-related items, ultrasonogram and autoantibodies were selected commonly, while TBII and uptake in hyperthyroidism, FNA, Tg and scintigram in nodular goiter were considered to be of specific needs. In summary, 5 or 6 items necessary on the initial tests of examining patients with 4 individual thyroid disorders were proposed.
Thyroid hormone has been used to reduce the size of sporadic nontoxic goiter since 1894. Noncontrolled clinical studies suggest that about two thirds of goiters respond to therapy, and a recent randomized clinical trial confirms the efficacy of suppressive therapy for sporadic nontoxic goiter. Efficacy is at least partly correlated with suppression of pituitary TSH production, response is usually evident by 3 months, relapse occurs when therapy is withdrawn, and nodular goiters may be less responsive than diffuse goiters. Some, but not all, series suggest that postoperative use of thyroid hormone suppressive therapy prevents recurrence of benign goiter. Three recent randomized trials suggest that thyroid hormone administered for 6 months to 3 years does not reduce the size of solitary thyroid nodules. About one third of nodules regressed in both treatment and placebo groups. Long-term studies are needed to define the effects of thyroid hormone suppressive therapy on the growth of goitrous lesions based on their underlying pathophysiology.
The author points out that natural history of sporadic nontoxic goiter (SNG) is characterized by increasing thyroid volume, nodularity and autonomy of function leading to hyperthyroidism in 13-16% of the patients after a medium follow-up of circa 12 years. Successively, the author reports and discusses the effectiveness and the outcome of the therapeutical modalities used for SNG: thyroidectomy, thyroid hormones and radioactive iodine.