Thyroid Function after Surgical Treatment of Nontoxic Goitre: A Randomized Study of Postoperative Thyroxine Administration

Geerdsen, J; Frølund, L.

doi:10.1111/j.0954-6820.1986.tb02775.x

Cited by 30 publications

(20 citation statements)

References 10 publications

(4 reference statements)

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“…2), and to a lesser degree in nonendemic areas [6,48]. Since most of these goiters grow by mechanisms other than increased thyrotropin (TSH) stimulation, treatment with suppressive doses of thyroid hormones is usually doomed to failure and is not recommended [34,[90][91][92][93].…”

Section: Goiter In Iodine-sufficient Areasmentioning

confidence: 99%

“…Furthermore, L-thyroxine administration can induce thyrotoxicosis in "simple" goiters which are already autonomous or non-TSH dependent [57,58,91,95]. Similarly, most studies agree that routine L-thyroxine treatment following surgery is of no value [57,58,92,[96][97][98]. Thus, L-thyroxine substitution therapy should be restricted to goitrous patients with concomitant hypothyroidism and for those developing this condition following surgery [57,58,91,93].…”

Section: Goiter In Iodine-sufficient Areasmentioning

confidence: 99%

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Endemic goiter and endemic thyroid disorders

1991

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The primary role of iodine deficiency in goitrogenesis and the prevention and treatment of endemic goiter by iodine supplementation is firmly established. Unfortunately, implementation of iodine prophylaxis programs has met with considerable technical and socioeconomic difficulties. Besides, lack of knowledge concerning some of the other causative factors of endemic goiter has prevented development of appropriate measures for its complete eradication in those areas where goiter persists in spite of prolonged and adequate iodine supplementation. At present, no less than 5% of the world's population have goiters and associated disorders, resulting in a public health and socioeconomic problem of major proportions. Seventy-five percent of people with goiter live in less developed countries where iodine deficiency is prevalent. Goiter prevalence rates of more than 50% and the highest frequency of severe cases of iodine deficiency disorders, namely, cretinism, congenital hypothyroidism, and various degrees of impairment of growth and mental development are found in endemic areas with extreme iodine deficiency. Goiters are usually multinodular and of very large size, producing, on occasion, signs of compression that require surgery. Recurrence rates are as high as 25-30% and second surgery accounts for 16% of all thyroidectomies. Unfortunately, most of these goiters occur in areas with highly restricted medical and surgical facilities. Twenty-five percent of people with goiters live in more developed countries where goiter continues to occur in certain areas despite iodine prophylaxis. Iodine-sufficient goiters are associated with autoimmune thyroiditis, hypothyroidism, hyperthyroidism, and thyroid carcinoma. Goiter is of considerable surgical significance in iodine-sufficient endemic areas and, to a lesser degree, in nonendemic areas where it is called "sporadic" goiter. Recurrence rates of iodine-sufficient goiter are 10-19% following thyroidectomy. Since most of these goiters grow by mechanisms other than increased thyrotropin (TSH) stimulation, treatment with suppressive doses of L-thyroxine is inefficient and, because of possible complications, not recommended. Although Graves' hyperthyroidism is not directly related to endemic goiter, it does relate adversely with ingestion or administration of iodine. At present, Graves' disease is treated with 131I or antithyroid drugs in more than 90% of the cases. The incidence rates of papillary, follicular, and anaplastic thyroid carcinomas appear to be related to endemic goiter and iodine supplementation, with surgery being required in essentially all of these cases.

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Section: Goiter In Iodine-sufficient Areasmentioning

confidence: 99%

Section: Goiter In Iodine-sufficient Areasmentioning

confidence: 99%

Endemic goiter and endemic thyroid disorders

1991

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“…This high probability of goiter recurrence after subtotal thyroidectomy resulted in a preventive use of LT4. However, only one ( 30 ) out of four randomized trials ( 27 , 30 – 32 ) has demonstrated LT4 to be effective in this setting.…”

Section: Surgerymentioning

confidence: 99%

Which Is the Ideal Treatment for Benign Diffuse and Multinodular Non-Toxic Goiters?

Knobel

2016

Front. Endocrinol.

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Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, neck tightness, and airway obstruction. In contrast, patients with such goiters who remain asymptomatic may be observed after exclusion of malignancy. The use of levothyroxine (LT4) to reduce the volume of the goiter is still a controversial treatment for large goiters, and the optimal surgical procedure for multinodular goiter is still debatable. Radioiodine is a safe and effective treatment option when used alone or in combination with recombinant human TSH. This review discusses current therapeutic options to treat diffuse and multinodular non-toxic benign goiters.

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“…Numerous studies have demonstrated that about two-thirds of thyroid goiters decrease in size in response to treatment with thyroid hormone [2,3]. Some thyroid carcinomas also decrease in size in response to treatment with thyroid hormone [4][5][6], and recurrent thyroid cancer is less common [7] and survival appears to be better in patients receiving thyroid hormone [8]. Increasing serum TSH levels is also the best way to increase serum thyroglobulin levels in patients with residual thyroid cancer [9].…”

Section: Invited Commentarymentioning

confidence: 99%

Effects of thyroxine on cell proliferation in human multinodular goiter: A study on growth of thyroid tissue transplanted to nude mice

et al. 1988

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To analyze the inhibitory effect of thyroxine (T4) on thyroid growth, freshly obtained biopsies of human nontoxic multinodular goiter tissue from 9 patients were transplanted to nude mice. After the implantation period, thyroid growth was stimulated by either hemithyroidectomy (HT) or by administration of the goitrogen propylthiouracil (PTU), with or without simultaneous administration of T4. During the latter period,3H‐thymidine was continuously administered by osmotic minipumps to label replicating cells. After processing of the tissue for autoradiography, the fraction of labeled cells (LI) was calculated. Following HT, the fraction of labeled cells in nontoxic multinodular goiter tissue was 4.8%. T4 significantly reduced the LI to 1.0%. The goitrogen induced transplant growth, the LI varying between 28% and 61% in the different specimens. Administration of T4 resulted in lower LI in all transplants: in 5 specimens the LI was similar to control transplants. In transplants from 3 goiter specimens, however, significantly higher LI were found. The present results show that administration of T4 significantly inhibits growth of human thyroid tissue. The effect seems, however, to vary in different specimens of nontoxic goiter, indicating a varying degree of autonomous replicating activity.

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Thyroid Function after Surgical Treatment of Nontoxic Goitre: A Randomized Study of Postoperative Thyroxine Administration

Cited by 30 publications

References 10 publications

Endemic goiter and endemic thyroid disorders

Endemic goiter and endemic thyroid disorders

Which Is the Ideal Treatment for Benign Diffuse and Multinodular Non-Toxic Goiters?

Effects of thyroxine on cell proliferation in human multinodular goiter: A study on growth of thyroid tissue transplanted to nude mice

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