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Thyroglobulin (Tg) is a protein which is synthesized in the thyroid. In healthy individuals only minute amounts of Tg can be found in the serum. In patients with thyroid disorders serum Tg levels are usually elevated, but the extent of this increase gives no indication of the nature of the underlying disease. Measurement of serum Tg is an established method in screening for thyroid disorders and in follow-up of patients with differentiated carcinomas of the thyroid. It seems likely that serum Tg determinations will also prove useful for other purposes (e.g. as an aid in deciding whether to treat a simple goiter by thyroid hormone administration or surgery). more...

The approach to the patient with a palpable solitary thyroid nodule remains controversial. In the rare patient with signs and symptoms suggestive of malignancy, the course of action is reasonably established. However, the patient with an asymptomatic solitary thyroid nodule presents a dilemma. The therapeutic alternatives range from suppressive medical therapy with serial examinations to surgical excision; therefore, to obviate unnecessary surgery, several diagnostic techniques and approaches have evolved which attempt to predict the presence of malignancy. A multitude of articles reflects the widespread disagreement among physicians regarding these diagnostic approaches. Thus, many questions still remain as to the proper management of patients with solitary nodules. The issue is further confounded by problems in assimilating and practically applying the results of the various studies, which often differ in their results. In this report, data regarding the prevalence of the solitary thyroid nodule are reviewed, and the clinical significance of the solitary thyroid nodule is discussed. The problem of management is examined in terms of the various diagnostic approaches to the solitary thyroid nodule: history and physical examination, laboratory tests, ultrasonography, thyroid suppressive therapy, scanning techniques, and fine-needle aspiration. The efficacy of each technique is critically evaluated with an emphasis upon the ability to distinguish benign from malignant disease. The overall aim of this report is to establish a reasonable diagnostic approach to the asymptomatic patient with the solitary palpable thyroid nodule, based upon a critical review of the literature. more...

Twenty patients, aged 18 to 34 years, with thyroid nodular disease detected during pregnancy from 1981 to 1984 were referred for surgical management. An additional five patients are now in the process of investigation and preparation for surgical treatment. Of the 20 patients, four were hyperthyroid and operation was indicated for medical intractability. In the remaining 16 patients there were seven cancers, for a 43% rate, and three instances of metastatic nodal disease. Needle aspiration biopsy represented the most important maneuver in clinical diagnosis but if strictly interpreted could give rise to errors in management. Two of 20 patients underwent midtrimester surgery will no ill effect on pregnancy. Operations varied in extent, tailored to the presenting problem, and produced no major complication. One stillbirth occurred in a patient with cancer who did not undergo surgery who was managed throughout her pregnancy by thyroid feeding. Hyperthyroidism in pregnancy bears a significant risk to the fetus and with medical failure surgery can be both effective and safe. The occurrence of cancer in a goiter of pregnancy should be appreciated. The principles of management should be conservative, consisting of needle biopsy, thyroid feeding and follow-up, and surgery, if indicated, preferably reserved for the midtrimester or puerperium. more...

The numbers of thyroidectomies in The Netherlands decreased by 35% in the period 1972-1986. The decline started in 1977 and was the result of a decrease in the numbers of thyroidectomies for nontoxic diffuse and nodular goitre, and for toxic diffuse and nodular goitre. The numbers of thyroidectomies for malignant and benign thyroid neoplasms remained unchanged. These findings can be explained by a decrease of the indication for surgery in nontoxic nodular goitre due to the introduction of fine needle aspiration cytology and an increase of the application of radioactive iodine in the treatment of toxic diffuse and nodular goitre. The decrease of the number of thyroidectomies for nontoxic goitre in the younger age groups is suggestive of a lower prevalence due to the improvement of the iodine supplementation. The mean hospital stay for thyroidectomy decreased from 19.5 to 10.1 days. The hospital mortality rate after partial thyroidectomies decreased from 6.6% to 0.9%. more...

Attitudes adopted when confronted with a solid cold thyroid nodule are analyzed in the light of recent developments in paraclinical data represented essentially by results of immunological, ultrasound and fine needle cytopuncture examinations. The use of these new surveillance technics frequently allows surgery to be deferred, while if on the contrary operation is decided then it usually now involves both thyroid lobes to avoid nodular recurrence and repeat surgery. Postoperative follow up surveillance is essential to ensure individual adaptation of attitude: therapeutic abstention, suppressive or possibly compensatory treatment. more...

On radioisotope scanning, thyroid nodules present one of five characteristic patterns. A "cold" nodule is most likely to be malignant and often necessitates surgery and functional ablation. However, any nodule that is growing and insuppressible probably should be removed. more...

Small-needle aspiration was practised up to 16 times (average 2.7 times) in 89 patients with cystic thyroid nodules. Re-examination 7 days to 22 months later showed that the nodule had disappeared or the amount of cystic fluid had decreased to 30% or less in 32 patients. All patients also received suppressive doses of thyroid hormones. It is suggested that additional injection of sclerosing fluid into the cyst may improve results further. more...