If, in the present state of our knowledge of the clinical manifestations of goiter, we undertake to operate on others than those that are unquestionably causing immediately grave, evidently correlated detriment, a very nice discrimination must be exercised. In young people it is probable that most of the enlargements are more or less physiologic, an effort to meet an increased demand; here if any treatment is indicated it certainly should not be of a destructive kind.
The real or fancied presence of a goiter is rather common. Even more common are individuals who are out in their functional adjustment; the neurasthenic, the highly strung person suffering from mental or physical overstrain, the early phthisic, or the patient suffering from any one of a number of chronic intoxications; many of these give a picture that may more or less closely resemble thyroid intoxication or irritation, and these individuals may have a
BLAIR VP. INDICATIONS FOR OPERATIVE INTERFERENCE IN GOITER. JAMA. 1915;LXIV(23):1896-1898. doi:10.1001/jama.1915.02570490012005