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To the internist it appears that thyroid disease has been regarded from a wholly surgical point of view. One gets the impression that thyroid enlargement is a condition in which surgical intervention is always indicated and that medical management is to be considered only as a preoperative measure or, perhaps, until the surgeon decides on a convenient time to operate.
Today such an attitude seems a bit irrational. Surely some patients with thyroid enlargement live out their life expectancy with the thyroid undisturbed, and doubtless some die from causes other than thyroid disease. It seems possible that some goiters may regress and disappear without untoward symptoms. Frank thyrotoxicosis has been known to undergo spontaneous and permanent remission. Such instances appear to be unknown to this author.
The etiology of thyroid disease is still obscure, and this obscurity is not lessened by Hertzler's discussion. He hesitates to state that deficiency of