TREATMENT OF BENIGN THYROID-DISEASE

The treatment of benign forms of thyroid disease is reviewed. Endemic goiter is a public health problem preventable by the addition of iodine to the food or water supply. Endemic and familial goiters are treated with replacement doses of l-thyroxine, as are sporadic colloid goiters and goiters resulting from chronic thyroiditis. Hyperfunctioning autonomous nodules without thyrotoxicosis and cystic nodules require no specific therapy. Prophylaxis against diffuse or nodular goiter after radiation to the head or neck for therapeutic purposes with thyroxine replacement therapy is debatable. All forms of hypothyroidism, including incipient types, require replacement thyroxine therapy, but this should be undertaken cautiously in older patients and in those with evidence of ischemic myocardial disease. Myxedema coma requires vigorous treatment and detailed supervision because of dismal mortality rates. lodine 131 is the treatment of choice in diffuse toxic goiter, but alternative forms of treatment have strong advocates. Varying dosage regimens appear to balance recurrence rate against postradiation hypothyroidism rate; we favor the medium-to-high dosage regimens and expect a high incidence of post 131l-hypothyroidism. The thiocarbamide antithyroid blocking agents have an associated low rate of hypothyroidism, but recurrence is common. The occasional severe complications, the high recurrence rate, and the long term of treatment make thiocarbamide treatment less desirable than radioactive iodine in most circumstances. Thyroidectomy for Graves' disease is efficacious, but recurrences and complications also make it less desirable than radioactive iodine therapy. The same considerations apply in the management of toxic nodular goiter. Transient forms of thyrotoxicosis are managed symptomatically with propranolol. Acute suppurative thyroditis and thyroid storm are medical emergencies requiring sedulous care. © 1979 Grune & Stratton, Inc.