[Therapy of euthyroid goiter].
In regions of iodine deficiency TSH-suppressive therapy with L-thyroxine is quite successful: 50-60% of euthyroid goitres shrink (almost) totally and an additional 15-20% undergo a clinically useful reduction in size. 100 micrograms L-thyroxine daily suppresses TSH secretion in 75% of patients and 150 micrograms daily in 95%. Reduction of goitre size takes four to six months' treatment, which must be continued on a lifelong basis. In regions of sufficient iodine supply (such as Switzerland today) treatment of euthyroid goitre is less successful because TSH-independent factors (thyroid stimulating immunoglobulins and possibly other yet unknown growth factors) assume relatively greater importance. In Denmark, for example, L-thyroxine reduces the size of only about 50% of goitres by only about 20% of their sonographic volume. In nonendemic regions goitres generally are not only less prevalent but also of smaller size. The indication for surgery therefore more rarely arises from pressure symptoms or cosmetic reasons, but rather from concern over potential malignancy. Cytologic examination of fine-needle aspirates is the most important method of ruling out malignant lesions and is far more important than scintigraphy or sonography. The general consensus is that surgery should be advised in all cytologically suspect lesions, in addition, of course, to the frankly malignant lesions.
Bürgi
H
H
Medizinische Klinik, Bürgerspital, Solothurn.
D001706:Biopsy; D002471:Cell Transformation, Neoplastic; D006043:Goiter, Endemic / Q000473:pathology / Q000628:therapy*; D006801:Humans; D008134:Long-Term Care; D013964:Thyroid Neoplasms / Q000517:prevention & control; D013965:Thyroidectomy; D013974:Thyroxine / Q000627:therapeutic use*
D013974:Thyroxine
Therapie des euthyreoten Kropfes.