Abstract
The records of patients treated at the Mayo Clinic for toxic multinodular goiter during 1950–1954, 1960–1964, and 1970–1974 were reviewed to compare results of surgical and131I therapy, to define trends in treatment policy and outcome, and to attempt to elucidate factors associated with posttreatment hypothyroidism. The series involved 446 patients who underwent thyroidectomy as initial treatment and 89 who initially received131I. The time to success was significantly shorter (p=0.001) in surgically treated patients than in patients initially receiving131I. Compared with patients treated medically, patients treated initially with surgery were much less likely to require a second treatment (0% versus 24%) during the first year after initial treatment. The probability of postthyroidectomy hypothyroidism increased from approximately 12% in the 1950s to more than 70% in the 1970s at 2 years after surgery. Neither more aggressive surgery nor use of more sensitive tests to diagnose hypothyroidism accounted for the increased probability in recent years.
Résumé
Les dossiers de malades traités par les auteurs pour goitre multinodulaire toxique de 1950 à 1954, de 1960 à 1964, et de 1970 à 1974 ont été revus pour comparer les résultats respectifs du traitement chirurgical et du traitement par l'I131, pour définir les tendances de l'attitude thérapeutique et de l'évolution, pour tenter d'élucider les facteurs associés à l'hypothyroïdisme secondaire au traitement. Les 3 séries concernent 446 malades qui ont été traités par l'I131. La période de temps nécessaire pour obtenir un bon résultat fut plus courte (p=0.001) chez les sujets traités chirurgicalement que chez ceux traités médicalement. Par comparaison avec ces derniers les premiers furent moins nombreux à recevoir un traitement secondaire de nécessité (0% contre 24%) au cours de la première année qui suivit le traitement initial. Le risque d'hypothyroïdie secondaire à la thyroïdectomie, 2 ans après l'intervention, s'est élevé de 12% dans la première série à 70% dans la troisième. L'augmentation du risque au cours des années les plus récentes dépend ni d'une attitude chirurgicale plus agressive ni de l'emploi de tests plus sensibles pour dépister l'hypothyroïdie.
Resumen
Se revisaron las historias clínicas de los pacientes con bocio tóxico multinodular tratados en el Mayo Clinic en los períodos 1950–1954, 1960–1964 y 1970–1974 con el objeto de comparar los resultados de la cirugía y de la terapia con131I, de definir las tendencias en las políticas terapéuticas y sus resultados, y de tratar de identificar factores asociados con el desarrollo de hipotiroidismo post tratamiento. La serie incluye 446 pacientes que fueron sometidos a tiroidectomía como tratamiento inicial y 89 que inicialmente recibieron131I. El intervalo entre el tratamiento y el efecto deseado fue significativamente más corto (p=0.001) en los pacientes tratados quirúrgicamente que en los pacientes que recibieron131I. Al compararlos con los pacientes de tratamiento médico, los pacientes inicialmente tratados con cirugía demostraron considerable menor necesidad de un segundo tratamiento (0% versus 24%) en el curso del primer año después del tratamiento inicial. La probabilidad de hipotiroidismo postirodectomía a los 2 años después de la cirugía aumentó de aproximadamente 12% en los años 1950's a más de 70% en los años 1970's. Ni la cirugía más agresiva ni el uso de métodos de diagnóstico del hipotiroidismo de mayor sensibilidad aparecen como factores de esta incrementada probabilidad observada en los años más recientes.
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Jensen, M.D., Gharib, H., Naessens, J.M. et al. Treatment of toxic multinodular goiter (hummer's disease): Surgery or radioiodine?. World J. Surg. 10, 673–679 (1986). https://doi.org/10.1007/BF01655554
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DOI: https://doi.org/10.1007/BF01655554