Abstract
It remains controversial whether or not nodular goiters should be treated surgically or conservatively. This report reviews our 9-year experience of treating nodular goiters in 334 patients, 44 of whom underwent surgery, and compares the methods of treatment employed from 1990 to 1999 with those employed from 1971 to 1989 when 171 operations were carried out. In accordance with diagnoses made using fineneedle aspiration biopsy (FNAB) and ultrasonography, patients were treated as follows. Those with cysts were given percutaneous ethanol injection therapy (PEIT), and those with solid tumors underwent surgery if cancer of >class 3 was suspected or if the tumors were >3cm. Consequently, 44 patients with solid tumors underwent surgery and 72 with cysts were treated by PEIT. The number of operations performed annually decreased to half of the pre-1990 figure. During the follow-up of those patients who did not undergo surgery, four with solid tumors and two with cysts later required surgery due to suspected carcinoma of > class 3 in 3 patients or as a result of personal choice in 3 patients. The growth of solid tumors was not able to be measured in most cases. These results indicate that the number of operations performed for nodular goiters can be reduced by PEIT. An accurate cytological diagnosis supports this therapeutic strategy.
Similar content being viewed by others
References
Vander JB, Gaston EA, Dawber TR (1954) Significance of solitary non toxic thyroid nodules. N Engl J Med 251:970–973
Stoffer RP, Welch JW, Hellwig CA, Chesky VE, McCurser EM (1960) Nodular goiter: incidence, morphology before and after iodine prophylaxis and clinical diagnosis. Arch Intern Med 106:10–16
Brander A, Viikinosky P, Nickels J, Kivisaari L (1991) Thyroid gland: US screening in a random adult population. Radiology 181:683–687
Mortensen JD, Woolner LB, Bennett WA (1955) Gross and microscopic findings in clinically normal thyroid glands. J Clin Endocrinol Metab 15:1270–1280
Gershengorn MC, McClung MR, Chu EW, Hanson TA, Weintraub BD, Robbins J (1977) Fine-needle aspiration cytology in the preoperative diagnosis of thyroid nodules. Ann Intern Med 87:265–269
Silverman JF, West RL, Larkin EW, Park HK, Finley JL, Swanson MS, Fore WW (1986) The role of fine needle aspiration biopsy in the rapid diagnosis and management of thyroid neoplasm. Cancer 57:1164–1170
Franklyn JA, Fitzgerald MG, Oates GD, Sheppard MC (1987) Fine needle aspiration cytology in the management of euthyroid goitre. Q J Med 65:997–1003
Rosen IB, Walfish PG, Miskin M (1975) The application of ultrasound to the study of thyroid enlargement: management of 450 cases. Arch Surg 110:940–944
Baskin HJ, Guarda LA (1987) Influence of needle biopsy on management of thyroid nodules: response to expand its use. South Med J 80:702–705
Leonard N, Melcher DH (1997) To operate or not to operate? The value of fine needle aspiration cytology in the assessment of thyroid swellings. J Clin Pathol 50:941–943
Meko JB, Norton J (1995) Large cystic/solid thyroid nodules. A potential false-negative fine-needle aspiration. Surgery 118:996–1004
Mehrotra A, Agarwal PK, Chandra T (1998) Cytopathology and AgNOR counts in fine-needle aspiration cytology smears of thyroid lesions. Diagn Cytopathol 19:238–243
Deshpand V, Kapilia K, Sai KS, Verma K (1997) Follicular neoplasms of the thyroid. Decision tree approach using morphologic and morphometric parameters. Acta Cytol 41:369–376
Zacks JF, de-las Morenas A, Beazley RM, O’Brien MJ (1998) Fine-needle aspiration cytology diagnosis of colloid nodule versus follicular variant of papillary carcinoma of the thyroid. Diagn Cytopathol 18:87–90
Faroux MJ, Theobald S, Pluot M, Patey M, Menzies D (1997) Evaluation of the monoclonal antibody antiperoxidase MoAb47 in the diagnostic decision of cold thyroid nodules by fine-needle aspiration. Pathol Res Pract 193:705–712
Davis NL, Gordon M, German E, Robins RE, McGregor GI (1991) Clinical parameters predictive of malignancy of thyroid follicular neoplasms. Am J Surg 161:567–569
Hancock SL, McDougall IR, Constine LS (1995) Thyroid abnormalities after therapeutic external radiation. Int J Radiat Oncol Biol Phys 31:1165–1170
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Kunori, T., Shinya, H., Satomi, T. et al. Management of nodular goiters and their operative indications. Surg Today 30, 722–726 (2000). https://doi.org/10.1007/s005950070084
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/s005950070084