Abstract
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 with131I 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.
Résumé
Le rôle essentiel de la carence en iode dans la genèse du goitre et la prévention et le traitement du goitre endémique grâce à un apport en iode sont établis avec certitude. Cependant, les programmes prophylactiques d'apport en iode ont rencontré d'énormes difficultés et techniques et socio-économiques. En outre, le manque de connaissances des autres facteurs qui provoquent le goitre endémique ont empêché le développement des mesures nécessaires à son éradication totale dans les cas où le goitre persiste malgré l'apport supplémentaire prolongé et suffisant d'iode. Aujourd'hui, au moins 5% de la population mondiale a un goitre et des désordres associés provoquant un grave problème dans la santé publique et en économie sociale. Soixante-quinze pour cent des gens avec goitre vivent dans les pays sous développés où le manque d'iode est fréquent. Des taux de goitres dépassant 50% de la population, et la grande fréquence de cas graves des désordres du manque d'iodine, en particulier le crétinisme, l'hypothyroïdisme congénital et les retards de croissance psychomotrice à des degrés divers se rencontrent dans les pays endémiques avec un déficit en iode. Les goitres sont en général multinodulaires et de grande taille, provoquant à l'occasion des signes de compression qui relèvent de la chirurgie. Les taux de récidive s'élèvent à 25–30% et la chirurgie secondaire compte 16% du nombre total des thyroïdectomies. Malheureusement, la plupart de ces goitres surviennent dans des régions où les possibilités médicales et chirurgicales sont extrêmement réduites. Vingt cinq pour cent des patients qui ont un goitre vivent dans des pays plus développés où il continue d'apparaître en dépit de l'apport prophylactique suffisant en iode. Les goitres survenant sans déficit en iode sont alors fréqemment associés à la thyroïdite auto-immune, à l'hypothyroïdie, à l'hyperthyroïdie et au cancer de la thyroïde. Le goitre occupe une place thérapeutique chirurgicale immense dans les pays d'endémie où l'iode ne manque pas et, à un degré moindre, dans les endroits non endémiques où il est appelé goitre “sporadique.” Le taux de récidive des goitres normoiodés est de 19% après thyroïdectomie. Puisque la plupart de ces goitres augmentent de volume autrement que par une stimulation accrue de thyrotropine, le traitement avec des doses suppressives de L-thyroxine est inefficace et, en raison des risques de complication, peu indiqué. Bien que la Maladie de Basedow ne soit pas directement en rapport avec le goitre endémique, elle est en rapport conversé avec l'ingestion d'iode. Elle se traite aujourd'hui avec131I ou des médicaments antithyroidiens dans plus de 90% des cas. L'incidence de cancers papillaires, folliculaires, et anaplasiques semblent être en rapport avec le goitre endémique et l'augmentation d'iode: la chirurgie est indiquée dans pratiquement tous ces cas.
Resumen
El papel primario de la deficiencia de yodo en la bociogénesis y en la prevención y tratamiento del bocio endémico mediante suplemento dietario de yodo, está bien establecido. Desafortunadamente los programas profilácticos mediante suplementación de yodo han encontrado dificultades de carácter técnico y socio-económico. Además, la falta de conocimientos relativos a otros factores causales de bocio endémico ha impedido el desarrollo de medidas adecuadas para lograr su total erradicación en áreas donde el bocio persiste a pesar de una adecuada suplementación de yodo. En la actualidad no menos del 5% de la población mundial está afectada por bocio y desórdenes asociados, lo cual resulta en problemas socio-económicos y de salud de proporciones mayores. Setenta y cinco por ciento de las personas afectadas por bocio residen en naciones de menor desarrollo, donde es frecuente la deficiencia de yodo. Tasas de prevalencia de bocio superiores a 50% y la mayor incidencia de casos graves de alteraciones por deficiencia de yodo, tales como cretinismo, hipotiroidismo congénito, y desarrollo mental anormal, se presentan en las regiones donde hay deficiencia extrema de yodo; los bocios son generalmente multinodulares y de gran tamaño, capaces de producir comprensión mecánica que demanda cirugía. Las tasas de recurrencia llegan hasta 25–30%, y la segunda cirugía representa el 16% de todas las tiroidectomías. Infortunadamente la mayoría de estos bocios se presentan en áreas donde las facilidades médicas y quirúrgicas son restringidas. El 25% de las personas con bocio viven en países de mayor desarrollo donde el bocio continúa presentándose a pesar de la profilaxis mediante suplementación dietaria. Los bocios con suficiencia de yodo se asocian con tiroiditis autoinmune, hipotiroidismo, hipertiroidismo, y carcinoma tiroideo. El bocio es de considerable pertinencia quirúrgica en áreas de bocio endémico con suficiencia de yodo, y en menor grado en áreas no endémicas, donde el bocio es de tipo “esporádico.” Las tasas de recurrencia del bocio con suficiencia de yodo son de 10–19% después de tiroidectomía. Puesto que la mayoría de estos bocios se desarrollan por mecanismos diferentes del estímulo por tirotropina (TSH) aumentada, el tratamiento con dosis supresoras de L-tiroxina es ineficaz y, por sus potenciales complicaciones, no recomendable. Aunque el hipertiroidismo de Graves no aparece directamente relacionado con el bocio endémico, sí se observan efectos adversos con la ingestión o la administración de yodo. En la actualidad la enfermedad de Graves es tratada con131I o con drogas antitiroideas en más del 90% de los casos. La incidencia de carcinomas tiroideos papilares, foliculares, y anaplásicos parece estar relacionada con el bocio endémico y con la suplementación de yodo, y la cirugia se halla indicada esencialmente en la totalidad de los casos.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Langer, P.: History of goiter. In Endemic Goiter, World Health Organization, editor, Monogr. Ser. 44, Geneva, WHO, 1960, pp. 9–25
Merke, F.: History and Iconography of Endemic Goitre and Cretinism, Lancaster, MTP Press Limited, 1984
Kelly, F.C., Sneeden, W.W.: Prevalence and geographical distribution of endemic goiter. In Endemic Goiter, World Health Organization, editor, Monogr. Ser. 44, Geneva, WHO, 1960, pp. 9–25
Matovinovic, J.: Endemic goiter and cretinism at the dawn of the third millenium. Annual Rev. Nutr.3:341, 1983
Hetzel, B.S., Dunn, J.T., Stanbury, J.B.: The Prevention and Control of Iodine Deficiency Disorders, Amsterdam, Elsevier, 1987
Stanbury, J.B., Hetzel, B.: Endemic Goiter and Endemic Cretinism, New York, Wiley & Sons, 1980
Dunn, J.T., Pretell, E.A., Daza, C.H., Viteri, F.E.: Towards the Eradication of Endemic Goiter, Cretinism and Iodine Deficiency, Washington, D.C., Pan Am. Health Org., No. 502, 1986
Gutekunst R., Scriba, P.C.: Goiter and iodine deficiency in Europe. IDD Newsletter4:1, 1988
Delange, F., Burgi, H.: Iodine deficiency disorders in Europe. Bull. WHO67:317, 1989
Mannar, M.G.V.: The status of IDD Control in ten East, Central and South African countries. IDD Newsletter5:1, 1989
Stanbury, J.B.: Endemic Goiter, Sci. Publ. 193, Washington, D.C., Pan Am. Health Org., 1969
Conference Report and Review: Survey of iodine deficiency disorders in Southeast Asia. IDD Newsletter5:7, 1989
Gaitan, E.: Goitrogens. In Hypothyroidism and Goitre: Clinical Endocrinology and Metabolism, J.H. Lazarus, R. Hall, editors, Philadelphia, Bailliere Tindall/Saunders, 1988, pp. 683–702
Gaitan, E.: Goitrogens in food and water. Annual Rev. Nutr.10:21, 1990
Gaitan, E.: Environmental Goitrogenesis, Boca Raton, CRC Press, 1989
Gaitan, E.: Iodine deficiency and toxicity. In Hemisph. Nutr. Congr. IV, P.L. White, N. Selvey, editors, Action, Massachusetts, Publishing Sciences, 1975, pp. 56–70
Delange, F., Dunn, J.T.: The definition of goiter stages. IDD Newsletter3:5, 1987
Ermans, A.M., Mbulamoko, N.B., Delange, F., Ahluwalia, R.: Role of Cassava in the Etiology of Endemic Goiter and Cretinims, IDRC-136e, Ottawa, Int. Dev. Res. Center, 1980
Osman, A.K., Fatah, A.A.: Factors other than iodine deficiency contributing to the endemicity of goitre in Darfur province (Sudan). J. Hum. Nutr.35:302, 1981
Osman, A.K.: Bulrush millet (Pennisetum typhoids) a contributory factor to the endemicity of goitre in western Sudan. Ecol. Food Nutr.11:121, 1981
Eltom, M., Hofvander, Y., Torelm, I., Fellstrom, B.: Endemic goitre in the Darfur region (Sudan): Epidemiology and aetiology. Acta Med. Scand.215:467, 1984
Elton, M., Salih, M.A.M., Bastrom, H., Dahlberg, P.A.: Differences in aetiology and thyroid function in endemic goitre between rural and urban areas of the Darfur region of the Sudan. Acta Endocrinol.108:356, 1985
Gaitan, E., Lindsay, R.H., Reichert, R.D., Ingbar, S.H., Cooksey, R.C., Legan, J., Meydrech, E.F., Hill, J., Kubota, K.: Antithyroid and goitrogenic effects of millet: Role of C-glycosylflavones. J. Clin. Endocrinol. Metab.68:707, 1989
Drexhage, H.A., Bottazo, G.F., Doniach, D., Bitensky, L., Chayen, G.F.: Evidence for thyroid-growth-stimulating immunoglobulins in some goitrous thyroid diseases. Lancet2:287, 1980
Wenzel, B.E., Bottazo, G.F.: Thyroid cell growth. Acta Endocrinol. (Copenh.)281[Suppl.]:215, 1987
Minuto, F., Barreca, A., Del Monte, P., Cariola, G., Torre, G.C., Giordeno, G.: Immunoreactive insulin-like growth factor 1 (IGF-1) and IGF-1-binding protein content in human thyroid tissue. J. Clin. Endocrinol. Metab.68:621, 1989
Gaitan, J.E., Mayoral, L.G., Gaitan, E.: Defective thyroidal iodine concentration in protein-calorie malnutrition. J. Clin. Endocrinol. Metab.51:327, 1983
Gaitan, E., Merino, H.: Antigoitrogenic effect of casein. Acta Endocrinol. (Copenh.)83:763, 1976
Matovinovic, J., Trowbridge, F.L.: North America. In Endemic Goiter and Endemic Cretinism, J.B. Stanbury, B. Hetzel, editors, New York, John Wiley and Sons, 1980, pp. 31–67
Gaitan, E., Merino, H., Rodriguez, G., Medina, P., Meyer, J.D., DeRouen, T.A., MacLennan, R.: Epidemiology of endemic goiter in western Colombia. Bull. WHO56:403, 1978
Gaitan, E.: Endemic goiter in western Colombia. Ecol. Dis.2:195, 1983
Gaitan, E., Cooksey, R.C., Meydrech, E.F., Legan, J., Gaitan, G.S., Astudillo, J., Guzman, R., Guzman, N.: Thyroid function in neonates from goitrous and nongoitrous iodine-sufficient areas. J. Clin. Endocrinol. Metab.69:359, 1989
Gaitan, E., Island, D.P., Liddle, G.W.: Identification of a naturally occurring goitrogen in water. Trans. Assoc. Am. Physicians82:141, 1969
Gaitan, E.: Water-borne goitrogens and their role in the etiology of endemic goiter. World Rev. Nut. Diet.17:53, 1973
Gaitan, E., Cooksey, R.C., Legan, J., Montalvo, J.M., Pino, J.A.: Simple goiter and autoimmune thyroiditis: Environmental and genetic factors. Clin. Ecol.3:158, 1985
Gaitan, E.: Iodine-sufficient goiter and autoimmune thyroiditis: The Kentucky and Colombia experience. In Frontiers in Thyroidology, G. Medeiros-Neto, E. Gaitan, editors, New York, Plenum, 1986, pp. 19–26
London, W.T., Koutras, D.A., Pressman, A., Vought, R.L.: Epidemiologic and metabolic studies of a goiter endemic in eastern Kentucky. J. Clin. Endocrinol. Metab.25:1091, 1965
Hollingsworth, D.R., Butcher, L.K., White, S.D.: Kentucky Appalachian goiter without iodine deficiency. Am. J. Dis. Child.131:866, 1967
Gaitan, E.: Thyroid disorders: Possible role of environmental pollutants and naturally occurring agents. Am. Chem. Soc. Div. Environ. Chem.26:58, 1986
Gaitan, E., Wahner, H.W., Correa, P., Bernal, R., Jubiz, W., Gaitan, J.E., Llanos, G.: Endemic Goiter in the Cauca Valley: I. Results and limitations of twelve years of iodine prophylaxis. J. Clin. Endocrinol. Metab.28:173, 1968
Gaitan, E., Wahner, H.W., Cuello, C., Correa, P., Jubiz, W., Gaitan, J.E.: Endemic goiter in the Cauca Valley: II. Studies of thyroid pathophysiology. J. Clin. Endocrinol. Metab.29:675, 1969
Wahner, H.W., Mayberry, W.E., Gaitan, E., Gaitan, J.E.: Endemic goiter in the Cauca Valley: III. Role of serum TSH in goitrogenesis. J. Clin. Endocrinol. Metab.32:491, 1971
Correa, P., Castro, S.: Survey of the pathology of thyroid glands from Cali, Colombia—A goiter Area. Lab. Invest.10:39, 1961
Gaitan, E., Wehmann, R.E., Cooksey, R.C., Meydrech, E.F.: Role of thyrotropin in goitrogenesis in children on adequate iodine intakes. Endocrinology120[Suppl.]:73, 1987
Welsh, R., Correa, P.: The comparative pathology of goiter in a nonendemic and an endemic area. Am. Med. Assoc. Arch. Pathol.66:694, 1960
Wahner, H.W., Gaitan, E., Correa, P.: Studies of iodine metabolism in endemic nodular goiter. J. Clin. Endocrinol. Metab.26:279, 1966
Studer, H., Ramelli, F.: Simple goiter and its variants: Euthyroid and hyperthyroid multinodular goiters. Endocrine Rev.3:40, 1982
Teuscher, J., Hans-Jacob, P., Gerber, H., Berchtold, R., Studer, H.: Pathogenesis of nodular goiter and its implications for surgical management. Surgery103:87, 1988
Gaitan, E.: Toxic nodular goiter (Plummer's disease) and Graves' disease: Differential diagnosis, clinical features and treatment. THYROID—University Case Reports, Vol. 2, No. 1, October, 1980
Vander, J.B., Gaston, E.A., Dawber, J.R.: The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann. Intern. Med.69:537, 1968
Van Herle, A.J., Rich, P.H., Ljung, B.-M.E., Ashcraft, M.W., Solomon, D.H., Keeler, E.B.: The thyroid nodule. Ann. Intern. Med.96:221, 1982
Rojeski, M.T., Gharib, H.: Nodular thyroid disease—Evaluation and management. N. Engl. J. Med.313:428, 1985
Mazzaferri, E.L., de los Santos, E.T., Rofagha-Keyhani, S.: Solitary thyroid nodule: Diagnosis and management. Med. Clin. North Am.72:1177, 1988
Gemsenjager, E., Staub, J.J., Girard, J., Heitz, P.H.: Preclinical hyperthyroidism in multinodular goiter. J. Clin. Endocrinol. Metab.43:810, 1976
Toft, A.D.: Use of sensitive immunoradiometric assay for thyrotropin in clinical practice. Mayo Clin. Proc.63:1035, 1988
Bregengard, C., Kirkegaard, Faber, J., Pouesen, S., Hasselstrom, K., Siersback-Nielsen, K.A.J., Friis, T.H.: Relationships between serum thyrotropin, serum free thyroxine (T4), and 3,5,3′-triiodothyronine (T3) and daily T4 and T3 production rates in euthyroid patients with multinodular goiter. J. Clin. Endocrinol. Metab.65:258, 1987
Blichert-Toft, M., Egedorf, J., Christiansen, C., Axelsson, C.K.: Function of pituitary-thyroid axis after surgical treatment of non-toxic nodular goitre. Acta Med. Scand.206:15, 1979
Westermark, K., Persson, C.P.A., Johansson, H., Karlsson, F.A.: Nodular goiter: Effects of surgery and thyroxine medication. World J. Surg.10:481, 1986
Editorial: Iodide-induced thyrotoxicosis. Lancet2:1072, 1972
Vidor, G.I., Stewart, J.C., Wall, J.R., Wangel, A., Hetzel, B.S.: Pathogenesis of iodine-induced thyrotoxicosis. Studies in Northern Tasmania. J. Clin. Endocr. Metab.37:901, 1973
Pendergast, W.J., Milmore, B.K., Marcus, S.C.: Thyroid cancer and thyrotoxicosis in the United States. Their relation to endemic goiter. J. Chron. Dis.13:22, 1961
Dunn, J.T., Medeiros-Neto, G.A.: Endemic goiter and cretinism: Continuing threats to world health. PAHO Sci. Publ. 292, Washington, D.C., Pan Am. Health Org., 1974
Stanbury, J.B.: Research on endemic goiter in Latin America. WHO Chron.24:537, 1970
Safran, M., Terri, L.P., Roti, E., Braverman, L.E.: Environmental factors affecting autoimmune thyroid disease. Endocrinol. Metab. Clin. North Am.16:327, 1987
Kohn, L.A.: The midwestern American “epidemic” of iodine-induced hyperthyroidism in the 1920's. Bull. N.Y. Acad. Med.52:770, 1976
Martins, M.C., Lima, N., Knobel, M., Medeiros-Neto, G.: Natural course of iodine-induced thyrotoxicosis (Jod Basedow) in endemic goiter area: A 5 year follow-up. J. Endocrinol. Invest.12:239, 1989
Fradkin, J.E., Wolff, J.: Iodine-induced thyrotoxicosis. Medicine (Baltimore)62:1, 1983
Martino, E., Safran, M., Aghini-Lombardi, F., Rajatanavin, R., Lenziardi, M., Fay, M., Pacchiarotti, A., Aronin, H., Machia, E., Haffajee, C.H., Oduguardi, L., Love, J., Bigalli, A., Baschieri, L., Pinchera, A., Braverman, L.: Environmental iodine intake and thyroid dysfunction during chronic amiodarone therapy. Ann. Intern. Med.101:28, 1984
Furszyfer, J., Kurland, L.T., Woolner, L.B., Elveback, L.R.: Hashimoto's thyroiditis in Olmsted County, Minnesota, 1935 through 1967. Mayo Clin. Proc.45:586, 1970
Weaver, D.K., Nishiyama, R.H., Burton, W.D., Batsakis, J.G.: Surgical thyroid disease: A survey before and after iodine prophylaxis. Arch. Surg.92:796, 1966
Weaver, D.K., Bafsakis, J.G., Nishiyama, R.H.: Relationship of iodine to “Lymphocytic Goiters.” Arch. Surg.98:183, 1968
Duque, E., Cuello, C., Correa, P.: Accion del tiempo en la prevalencia de bocio en el Valle del Cauca despues de la yodizacion de le sal. Patologia (Mexico)14:81, 1976
Harach, H.R., Escalante, D.A., Onativia, A., Lederer, O.J., Day, E.S., Williams, D.A.: Thyroid carcinoma and thyroiditis in an endemic goitre region before and after iodine prophylaxis. Acta Endocrinol.108:55, 1985
Gaitan, E., MacLennan, R., Island, D.P., Liddle, G.W.: Identification of water-borne goitrogens in the Cauca Valley of Colombia. In Trace Substances in Environmental Health-V, D.P. Hemphill, editor, University of Missouri, Columbia, Missouri, 1972, pp. 55–67
Gaitan, E., Duque, E., Gallo, H., Guzman, N., Cooksey, R.C., Legan, J.: Melanin-like cytoplasmic granules in thyroid cells of Colombian iodine-sufficient goiters. Clin. Res.34:213A, 1986
Orrego, A., Echeverri, M.C., Balthazar, R., Uribe, F., Orozco, B.: Bocio en ninos y adolescentes—Estudio de tiroiditis de Hashimoto mediante biopsia tiroidea por aspiracion. Acta Med. Colomb.14:19, 1989
Suzuki, H., Higuchi, T., Sawa, K., Ohtaki, S., Horiuchi, Y.: Endemic coast goitre in Hokkaido, Japan. Acta Endocrinol.50:161, 1965
Shimpo, K., Onoe, T., Fukushima, T.: Endemic goiter in Hokkaido, with special reference to the histopathological findings. J. Pathol. (Byorigaku Zasshi)2:77, 1943
Zimmermann, L.M., Wagner, D.H.: Relation of nodular goiter to thyroid carcinoma. In Clinical Endocrinology, G.B. Astwood, editor, New York, Grune & Stratton Inc., 1960, pp. 160–167
Saxen, E.A.: Carcinoma thyroideae and its incidence in Finland. Acta Chir. Scand.1[Suppl. 156]:60, 1950
Wahner, H.W., Cuello, C., Correa, P., Uribe, L.F., Gaitan, E.: Thyroid carcinoma in an endemic goiter area. Cali, Colombia. Am. J. Med.40:58, 1966
Correa, P., Llanos, G.: Morbidity and mortality from cancer in Cali, Colombia. J. Natl. Cancer Inst.36:717, 1966
Cuello, C., Correa, P., Eisenberg, H.: Geographic pathology of thyroid carcinoma. Cancer23:230, 1969
Christensen, S.B.: Natural history of thyroid carcinoma. Lancet2:1428, 1985
Freeman, S.L., Hay, I.D., Beogstralh, E.J., Goellener, J.R., Offord, K.P., Kurland, L.T.: Epidemiology, treatment and outcome of thyroid carcinoma through five decades. Endocrinology119[Suppl.]:T-65, 1986
DeGroot, L.J.: Diagnostic approach and management of patients exposed to irradiation to the thyroid. J. Clin. Endocrinol. Metab.69:925, 1989
Silverberg, E.: Cancer statistics. 1990 CA-A Cancer Journal for Clinicians40:9, 1990
Ma, X., Ma, Y., Fhon, D., Shi, K., Zhan, P., Gu, Y.: Surgical treatment of endemic goitre. Symp. on Iodine Deficiency Disorders (IDD), Asia-Oceania Thyroid Association (AOTA), Tianjin, China, April 24–25, 1989, p. 55
Pfannenstiel, P.: The cost of continuing iodine deficiency in the Federal Republic of Germany. IDD Newsletter5:7, 1989
Studer, H., Peter, H.J., Gerber, H.: Toxic nodular goitre. Clin. Endocrinol. Metab.14:351, 1985
Persson, C.P.A., Johansson, H., Westermark, K., Karlsson, F.A.: Nodular goiter—Is thyroxine medication of any value? World J. Surg.6:391, 1982
Geerdsen, J.P., Frolund, L.: Recurrence of non-toxic goitre with and without postoperative thyroxine medication. Clin. Endocrinol.21:529, 1984
Geerdsen, J.P., Hee, P.: Non-toxic goitre. II A study of the pituitary—Thyroid axis in 14 recurrent cases. Acta Chir. Scand148:225, 1982
Hansen, J.M., Kampmann, J., Madsen, S.N.: L-thyroxine treatment of diffuse non-toxic goiter evaluated by ultrasonic determination of thyroid volume. Clin. Endocrinol.10:1, 1979
Hazard, J., Simon, D.: Treatment of endemic and sporadic goiter. Annales d'Endocrinologie49:306, 1988
Hedman, I., Jansson, S., Lindberg, S.: Need for thyroxine in patients lobectomised for benign thyroid disease as assessed by follow-up on average fifteen years after surgery. Acta Chir. Scand.152:481, 1986
Geerdsen, J.P., Frolund, L.: Thyroid function after surgical treatment of non-toxic goitre—A randomized study of postoperative thyroxine administration. Acta Med. Scan.220:341, 1986
Hegedus, L., Hansen, J.M., Veiergang, Karstrup, S.: Does prophylactic thyroxine treatment after operation for non-toxic goitre influence thyroid size? Br. Med. J.294:801, 1987
Iversen, O., Vagn Nielsen, O., Bagge, E.: Surgical treatment of non-toxic goiter. Dan. Med. Bull.10:65, 1963
Geerdsen, J.P., Hee, P.: Non-toxic goitre I. Surgical complication and long-term prognosis. Acta Chir. Scand.148:221, 1982
Bergfelt, G., Risholm, L.: Postoperative thyroid hormone therapy in non-toxic goitre. Acta Chir. Scand.126:531, 1963
Feldt-Rasmussen, U., Blichert-Toft, M., Date, J., Haas, V.: Serum thyroglobulin concentration in nontoxic goiter and response to surgery with special reference to risk of goiter relapse. World J. Surg.10:566, 1986
Husby, S., Blichert-Toft, M., Bang, U., Nielsen, B.: Investigation of TSH dependency, circulating thyroid autoantibody, and morphological features of recurrent non-toxic goitre. Acta Med. Scand.217:61, 1985
Kay, T.W.H., d'Emden, M.C., Andrew, J.T., Martin, F.I.R.: Treatment of non-toxic multinodular goiter with radioactive iodine. Am. J. Med.84:12, 1988
Glinoer, D., Hesch, D., Lagasse, R., Lanberg, P.: The management of hyperthyroidism due to Graves' disease in Europe in 1986—Results of an International Survey. Acta Endocrinologica115[Suppl. 285]:1, 1987
Solomon, B., Glinoer, D., Lagasse, R., Wartofsky, L.: Current trends in the management of Graves' disease. J. Clin. Endocrinol. Metab.70:1518, 1990
Bradley, III, E.L., Liechty, R.D.: Modified subtotal thyroidectomy for Graves' disease. A two institution study. Surgery94:955, 1983
Ozoux, J.P., de Calan, L., Portier, G., Rivallain, B., Favre, J.P., Robier, A., Goga, D., Brizon, J.: Surgical treatment of Graves' disease. Am. J. Surg.156:177, 1988
Schroder, D.M., Chambors, A., France, C.J.: Operative strategy for thyroid cancer. Is total thyroidectomy worth the price? Cancer58:2320, 1986
Brooks, J.R., Starnes, H.F., Brooks, D.C., Pelkey, J.N.: Surgical therapy for thyroid carcinoma: A review of 1249 solitary thyroid nodules. Surgery104:940, 1988
Hamming, J.F., Van de Velde, C.J.H., Gosling, B.M., Fleuren, G.J., Hermans, J., Delemarre, J.F., van Slooten, E.A.: Peroperative diagnosis and treatment of metastases to the regional lymph nodes in papillary carcinoma of the thyroid gland. Surg. Gynecol. Obstet.169:107, 1989
Clark, R.L., White, E.C., Russel, W.O.: Total thyroidectomy for cancer of the thyroid: Significance of intraglandular dissemination. Ann. Surg.149:838, 1959
Clark, O.H.: Total thyroidectomy: The treatment of choice for patients with differentiated thyroid cancer. Ann. Surg.196:361, 1982
Donahue, J.H., Goldfien, S.D., Miller, T.R., Abele, J.S., Clark, O.H.: Do the prognoses of papillary and follicular carcinoma differ? Am. J. Surg.148:168, 1984
Arganini, M., Behar, R., Wu, T.C., Straus, II, F., McCormick, M., DeGroot, L.J., Kaplan, E.L.: Hürthle cell tumors: A twenty five year experience. Surgery100:1108, 1986
Gosain, A.K., Clark, O.H.: Hürthle cell neoplasms: Malignant potential. Arch. Surg.119:515, 1984
Gundry, S.R., Burney, R.E., Thompson, N.W., Lloyd, R.: Total thyroidectomy for Hürthle cell neoplasm of the thyroid. Arch. Surg.118:529, 1983
Cady, B., Cohn, K., Rossi, R.L., Sedgewick, C.E., Meissner, W.A., Werber, J., Gelman, R.S.: The effect of thyroid hormone administration upon survival in patients with differentiated thyroid carcinoma. Surgery94:978, 1983
Mazzaferri, E.L., Young, R.L.: Papillary thyroid carcinoma: A 10 year follow-up report of the impact of therapy in 576 patients. Am. J. Med.70:511, 1981
Bäckdahl, M., Wallin, G., Löwhagen, T., Aver, G., Granberg, P.O.: Fine needle biopsy cytology and DNA analysis: Their place in the evaluation and treatment of patients with thyroid neoplasms. Surg. Clin. North Am.67:197, 1987
Hay, I.D.: Prognostic factors in thyroid carcinoma. Thyroid Today12:1, 1989
Niederle, B., Roka, R., Schemper, M., Fritsch, A., Weissel, M., Ramach, W.: Surgical treatment of distant metastases in differentiated thyroid cancer: Indication and results. Surgery100:1088, 1986
Wood, Jr., W.J., Singletary, S.E., Hickey, R.C.: Current results of treatment for distant metastatic well-differentiated thyroid carcinoma. Arch. Surg.124:1374, 1989
Refetoff, S., Lever, E.G.: The value of serum thyroglobulin measurement in clinical practice. J. Am. Med. Assoc.250:2352, 1983
Ryff-de Leche, A., Staub, J.J., Koher-Faden, R., Muller-Brand, J., Heitz, P.U.: Thyroglobulin production by malignant thyroid tumors. An immunocytochemical and radioimmunoassay study. Cancer57:1145, 1986
Tallroth, E., Wallin, G., Lundell, G., Löwhagen, T., Einhorn, J.: Multimodality treatment in anaplastic giant cell thyroid carcinoma. Cancer60:1428, 1987
Werner, B., Abele, J., Alveryd, A., Björklund, A., Franzén, S., Granberg, P.-O., Landberg, T., Lundell, G., Löwhagen, T., Sundblad, R., Tennvall, J.: Multimodal therapy in anaplastic giant cell thyroid cancer. World J. Surg.8:64, 1984
Author information
Authors and Affiliations
Additional information
Supported by grants from the Veterans Administration Medical Research Service of the United States and the Colombian National Science Foundation (COLCIENCIAS).
Rights and permissions
About this article
Cite this article
Gaitan, E., Nelson, N.C. & Poole, G.V. Endemic goiter and endemic thyroid disorders. World J. Surg. 15, 205–215 (1991). https://doi.org/10.1007/BF01659054
Issue Date:
DOI: https://doi.org/10.1007/BF01659054