Ugeskrift for laeger · 2001
[Danish endocrinologists' examination and treatment of non-toxic multinodular goiter. A questionnaire study].
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Bonnema S J, Bennedbaek F N, Hegedüs L
Аннотация
AIM: To assess the attitudes towards the management of the non-toxic multinodular goitre by means of a questionnaire concerning on case history, which was circulated to all Danish endocrinologists ("A 42-year-old woman with an irregular, non-tender, bilaterally enlarged thyroid of 50-80 g and no clinical suspicion of malignancy").
DESIGN: Eleven variations of the (basic) case report were proposed in order to evaluate the impact on the management of each alteration. In the index case, serum TSH was the routine choice of 100%, serum T4/free T4-index and T3/free T3-index were measured by 83% and 79%, serum TPOab and serum calcitonin by 49% and 4%, respectively.
RESULTS: The median number of blood tests was three (range 1-7). Thyroid scintigraphy was used by 96% and ultrasound by 94%, both methods were employed by 90% with scintigraphy most often having the first priority. Fine-needle aspiration biopsy was not routinely used, unless a scintigraphically dominant "cold" area was present; 70% used ultrasound guidance. Radioiodine was the preferred treatment of 51%, surgery 7%, L-T4 4%, and no treatment 38%.
DISCUSSION: In the case of young patients or factors predisposing to thyroid cancer, treatment preferences changed to surgery. The prevailing use of radioiodine in Denmark contrasts with the situation in most other European countries, but Danish endocrinologists also disagree about the optimum management of multinodular non-toxic goitre.
DESIGN: Eleven variations of the (basic) case report were proposed in order to evaluate the impact on the management of each alteration. In the index case, serum TSH was the routine choice of 100%, serum T4/free T4-index and T3/free T3-index were measured by 83% and 79%, serum TPOab and serum calcitonin by 49% and 4%, respectively.
RESULTS: The median number of blood tests was three (range 1-7). Thyroid scintigraphy was used by 96% and ultrasound by 94%, both methods were employed by 90% with scintigraphy most often having the first priority. Fine-needle aspiration biopsy was not routinely used, unless a scintigraphically dominant "cold" area was present; 70% used ultrasound guidance. Radioiodine was the preferred treatment of 51%, surgery 7%, L-T4 4%, and no treatment 38%.
DISCUSSION: In the case of young patients or factors predisposing to thyroid cancer, treatment preferences changed to surgery. The prevailing use of radioiodine in Denmark contrasts with the situation in most other European countries, but Danish endocrinologists also disagree about the optimum management of multinodular non-toxic goitre.