The DIAGONALE study: a survey designed to analyze the diagnosis and management of goiter in France.
OBJECTIVE
Euthyroid goiter is frequent for general practitioners (GPs) and endocrinologists (ENDOs). It may induce complications especially in elderly subjects when it becomes nodular and hyperfunctional whereas in young subjects prevention of iodine deficiency may prevent this evolution. The primary objective of the observational study diagnosis of iodine deficiency induced goiter and national medical practices (DIAGONALE) was to determine the circumstances of diagnosis of euthyroid goiter, its incidence, the patient characteristics and the management.


METHODS
A representative sample of GPs and ENDOs working in a private medical practice (exclusively or not) was randomly drawn from a national file without changing the physician-patient relationship.


RESULTS
Four hundred and sixty-nine GPs and 195 ENDOs participated in the study. Goiter was diagnosed in 0.86% of patients seen by GPs and 15.7% of patients seen by ENDOs. Pregnant women were mainly and teenagers exclusively seen by ENDOs. The interview and clinical examination were an important time in the management of euthyroid goiter. TSH level was systematically assayed as well as an ultrasonography; 22.6% of GPs did not perform a scintigraphy versus 63.1% of ENDOs. Levothyroxine treatment was frequently prescribed and the objective of TSH levels was 2mU/L for GPs and 1mU/L for ENDOs.


CONCLUSIONS
This observational study showed differences in the management of euthyroid goiter between GPs and ENDOs but also many common practices. It also highlighted a higher incidence rate of goiter in pregnant women and teenagers seen by ENDOs.
Service d'endocrinologie, maladies métaboliques et nutrition, CHU Larrey, 24, chemin de Pouvourville, TSA 30030, 31059 Toulouse cedex 9, France. caron.p@chu-toulouse.fr
Philippe
P
Caron
Philippe
P
Lehert
Sylvie
S
Picard
Frédéric
F
Landron
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D015415:Biomarkers; D002648:Child; D003625:Data Collection; D019468:Disease Management; D004704:Endocrinology / Q000706:statistics & numerical data*; D005260:Female; D005602:France / Q000453:epidemiology; D058006:General Practice / Q000706:statistics & numerical data*; D006042:Goiter / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007455:Iodine / Q000172:deficiency / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D011331:Private Practice; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012494:Sampling Studies; D011795:Surveys and Questionnaires; D013963:Thyroid Hormones / Q000097:blood; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000627:therapeutic use; D055815:Young Adult
D015415:Biomarkers; D013963:Thyroid Hormones; D013972:Thyrotropin; D007455:Iodine; D013974:Thyroxine