Management of the nontoxic multinodular goiter in Latin America: comparison with North America and Europe, an electronic survey.
To assess diagnostic and therapeutic approaches to nontoxic multinodular goiter and to compare them with previously reported American Thyroid Association (ATA) and European Thyroid Association (ETA) surveys, an online questionnaire was distributed to Latin American Thyroid Society (LATS) members. An index case was presented (42-yr-old woman with an enlarged, irregular, nontender, 50- to 80-g thyroid and no clinical suspicion of malignancy or dysfunction), and 11 variations were proposed to evaluate how each alteration would affect management. We obtained 148 responses (response rate, 50%). In the index case, the most used blood tests were TSH (96%), antithyroid peroxidase antibodies (76%), and free T(4) (64%); 5% included a calcitonin assay. Nearly 90% would perform ultrasound, and only 16% used scintigraphy. Fine needle biopsy was indicated by 88%, with ultrasound guidance in 75% of times. For treatment, observation was preferred by 39%, surgery by 28%, levothyroxine by 21%, and radioiodine by 7% (60% with recombinant TSH prestimulation). A suppressed TSH level prompted 45% of the respondents to recommend radioiodine, whereas 70-78% indicated surgery in the presence of a large goiter or suspicion of malignancy. In conclusion, no consensus exists concerning the ideal management of nontoxic goiter among LATS members, in agreement with previous ATA and ETA surveys. Levothyroxine therapy is less used by LATS than by ATA or ETA members, and a more aggressive therapeutic strategy is generally preferred by members of LATS and ETA compared with ATA.
Serviço de Endocrinologia, Centro de Ciências da Saúde, Universidade Estadual de Londrina, Avenue Robert Koch 60, Londrina, Paraná, Brazil 86.038-350. drgaucho@yahoo.com.
Leandro Arthur
LA
Diehl
Valdinei
V
Garcia
Steen J
SJ
Bonnema
Laszlo
L
Hegedüs
Claudio Cordeiro
CC
Albino
Hans
H
Graf
D000328:Adult; D004581:Electronics; D005060:Europe; D005260:Female; D006044:Goiter, Nodular / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D007843:Latin America; D009656:North America; D011795:Surveys and Questionnaires