Treatment of Goiter in Children
1. THE changing picture of endemic goiter. With the increased transportation of frozen foods from one portion of the country to another, and with the widespread use of iodized salt, there are few if any areas in the United States where most people do not receive an adequate amount of iodine. For this reason, the naturally iodine-deficient areas, in which goiter formerly was endemic, no longer produce a high incidence of goiter. In the areas in which goiter once was endemic, the goiters that are seen today are sporadic and familial rather than endemic in character. Because these goiters rarely are the result of iodine deficiency, treatment with iodine is not apt to be helpful.
2. Nontoxic diffuse goiter. Two types of nontoxic diffuse goiter occur today in children. One may be called “hypofunctional hyperplasia” of the thyroid, and the other is struma lymphomatosa.
(a) Hypofunctional hyperplasia. This condition may be seen in newborn infants; it may occur in early infancy; or it may develop during childhood. It is characterized by a high uptake of radioiodine (I131) usually without an increase in the amount of protein-bound iodine. The basic defect is the failure of the thyroid gland to synthesize properly functioning thyroid hormone. The thyroid may maintain its ability to concentrate iodine, but it cannot incorporate the iodine into a properly functioning hormone.1 For this reason, hypothyroidism develops; the pituitary is stimulated to increase its output of thyrotropic hormone; the thyroid responds by hypertrophy and hyperplasia; and a diffuse goiter. . .