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Article
July 1960

Nodular Goiter: Incidence, Morphology Before and After Iodine Prophylaxis, and Clinical Diagnosis

Author Affiliations
Halstead, Kan.
From the Division of Endocrinology, Hertzler Clinic and Hertzler Research Foundation, Halstead, Kan.
Arch Intern Med. 1960;106(1):10-14. doi:10.1001/archinte.1960.03820010012004
Abstract

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'

References
1.
Boley, J. O., Kansas City; Fink, A. A., Topeka; Helwig, F. C., Kansas City; Reals, W. J., and Stofer, B. E., Wichita, and Weber, C. J., Salina.
2.
Beahrs, O. H.; Pemberton, J. dej., and Black, B. M.:  Nodular Goiter and Malignant Lesions of the Thyroid Gland ,  J. Clin. Endocrinol. 11:1157-1165 ( (Oct.) ) 1951.Crossref
3.
Beierwaltes, W. H.; Johnson, P. C., and Solari, A. J.:  Clinical Use of Radio-Isotopes . Philadelphia, W. B. Saunders Company, 1957.
4.
Breitner, B.:  Konservative und operative Therapie beim euthyreoten Kropf ,  Wien. klin. Wchnschr. 62:73-75 ( (Feb. 3) ) 1950.
5.
Crile, G., Jr., and Dempsey, W. S.:  Indications for Removal of Nontoxic Nodular Goiters ,  J.A.M.A. 139:1247-1251 ( (April 30) ) 1949.Crossref
6.
Eberbach, C. W.:  Surgical Indications in Nontoxic Nodular Goiter: A Controversial Problem ,  Wisconsin M.J. 58:209-214 ( (April) ) 1959.
7.
Greer, M. A., and Astwood, E. B.:  Treatment of Simple Goiter with Thyroid ,  J. Clin. Endocrinol. 13:1312-1331 ( (Nov.) ) 1953.Crossref
8.
Hellwig, C. A.:  The Thyroid Gland in Kansas ,  Am. J. Clin. Path. 5:103-111 ( (March) ) 1935.
9.
Personal communications to the authors from Morton Salt Company and Carey Salt Company, Hutchinson, Kan. Iodized salt was first sold in Kansas in 1924.
10.
Joll, C. A.:  Diseases of the Thyroid Gland , St. Louis, The C. V. Mosby Company, 1932, p. 263.
11.
Personal communication to the authors from the Kansas State Board of Health, Topeka, Kan.
12.
Lahey, F. H., and Hare, H. F.:  Malignancy in Adenomas of the Thyroid ,  J.A.M.A. 145:689-695 ( (March 10) ) 1951.Crossref
13.
Mustacchi, P., and Cutler, S. J.:  Some Observations on the Incidence of Thyroid Cancer in the United States ,  New England J. Med. 255: 889-893 ( (Nov. 8) ) 1956.Crossref
14.
Perlmutter, M., and Slater, S. L.:  Which Nodular Goiters Should Be Removed: A Physiologic Plan for the Diagnosis and Treatment of Nodular Goiter ,  New England J. Med. 255:65-71 ( (July 12) ) 1956.Crossref
15.
Sokal, J. E.:  The Problem of Malignancy in Nodular Goiter: Recapitulation and a Challenge ,  J.A.M.A. 170:405-412 ( (May 23) ) 1959.Crossref
16.
Vander, J. B.; Gaston, E. A., and Dawber, T. R.:  Significance of Solitary Nontoxic Thyroid Nodules: Preliminary Report ,  New England J. Med. 251:970-973 ( (Dec. 9) ) 1954.Crossref
17.
Thalmann, A.: Die Häufigkeit der Struma Maligna am Berner Pathologischen Institut von 1910-1950 und ihre Beziehung zur Iodprophylaxie des enem. Kropfes. Inauguration Dissertation, Basel, Benno Schwabe & Co., 1954.
18.
Wölfler, A.:  Die chirurgische Behandlung des Kropfes , Berlin, August Hirschwald, 1890.
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