During the last few years the treatment of the average case of goiter has been quite satisfactorily standardized as the result of the management of many thousands of cases, mostly in the hands of relatively few surgeons. However, every one interested in these cases, no matter how experienced he may be, occasionally faces conditions involving the thyroid alone, or complicated with other pathologic conditions, which are of sufficient gravity to tax his judgment to the utmost. A too high mortality, even in desperate risk cases, brings discredit on surgery and influences many, who might safely obtain relief, not to have a timely operation. On the other hand, careful study and elimination of some cases, with greater experience and improvement in methods of dealing with these cases, has made it possible each year to extend the range of operability to other cases which at first sight were apparently regarded as hopeless.
TINKER MB. THE DESPERATE RISK GOITER. JAMA. 1922;79(16):1291-1297. doi:10.1001/jama.1922.02640160011004