During the last 70 years the treatment of nodular goiter has been the domain of the surgeon (Wölfler 17). The size of the goiter, its pressure on air passages and blood vessels, and the presence of or future danger of toxic symptoms (especially of goiter heart) were the principal indications for its removal. The possibility that an occult carcinoma might be present was another reason for advising thyroidectomy.
This rigid standpoint has been challenged recently by two papers. Sokal14 concluded from extensive statistical studies that malignancy among nodular goiters is extremely rare. He objects, therefore, to the routine removal of nodular goiters and limits surgical treatment to carefully selected cases in which malignancy is suspected.
Greer and Astwood6 repopularized the treatment of nodular goiter with thyroid extract. They reported that solitary adenomas as well as multinodular colloid goiters may disappear after thyroid medication. In their opinion, several months'
STOFFER RP, WELCH JW, HELLWIG CA, CHESKY VE, McCUSKER EN. Nodular Goiter: Incidence, Morphology Before and After Iodine Prophylaxis, and Clinical Diagnosis. AMA Arch Intern Med. 1960;106(1):10–14. doi:10.1001/archinte.1960.03820010012004
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