Fate of the non-operated, non-toxic goitre in a defined population
Winbladh A, Järhult J
Br J Surg. 2008;95:338-343
Summary
Does every patient with a benign goiter need surgery? To answer this question, the study authors reviewed data on 261 patients (median age, 56 years) who, at the time of clinical examination or after fine-needle aspiration (233 patients), did not wish or appear to need surgery. During a median follow-up period of 130 months, 36% of these patients had an additional surgical evaluation. Of the original group, 57 underwent surgery; 5 patients were diagnosed with thyroid cancer; and 13 developed thyrotoxicosis.
Viewpoint
Within this group, 95% of the patients were satisfied with a "watch and wait" policy, even though about 20% eventually required surgery. The risk of developing thyroid cancer over a 10-year period was low — less than 2% — but 3 of the 5 elderly patients with thyroid cancer died. This report confirmed that most patients with a clinically and pathologically benign goiter will not require surgery. However, a real — even if minimal — risk for thyroid cancer exists for patients in the "watchful waiting" group.
Winbladh A; Järhult J
Department of Surgery, Highland Hospital, Eksjö, Sweden.
BACKGROUND: There is lack of consensus in Europe regarding the management of patients with benign goitre. This study evaluated the long-term results of recommending no surgery for clinically and cytologically benign goitre. METHODS: Some 261 patients (median age 56 years) referred for surgical evaluation for goitre were followed prospectively for a median of 130 months. All hospital and primary care charts were reviewed and living patients interviewed by telephone. RESULTS: During follow-up, 36.4 per cent of patients were re-referred for a new surgical evaluation, mainly because of growth of the goitre and/or worsening of local symptoms. Fifty-seven (21.8 per cent) of the patients had surgery, and 13 developed thyrotoxicosis. Five patients (1.9 per cent) were diagnosed with thyroid carcinoma, three of whom (all elderly women) died from the disease. Some 95.0 per cent of patients were satisfied with the expectant policy, but 13.1 per cent had been worried about thyroid cancer despite the reassurance of a benign diagnosis. CONCLUSION: Patients with benign goitre can be treated conservatively with good results. However, there is a small risk that aggressive carcinoma will develop and about a quarter of patients may need surgery within 10 years of the decision to wait and see.
Reviewed by Dr. Ramaz Mitaishvili
