Current Methods of Diagnosis and Management of Goiter
E. PERRY McCULLAGH, M.D.
Department of Endocrinology and Metabolism
GOITER, for consideration in this report, will be discussed from the viewpoint of three types: nodular goiter, Graves’ disease, and thyroiditis. The specific methods most useful today in the diagnosis and management of these are the subject of this paper.
Diagnosis. Nodular goiter is a disease of adult life, commonest in women about middle age or older. In a patient with multinodular goiter, hyperthyroidism may be suspected for many reasons; some of the commonest are unexplained loss in weight and poorly explained tachycardia or bouts of atrial fibrillation. A nodule, especially if it seems to be solitary, which is hard and growing, must seriously be suspected of malignancy. A radioiodine (I131) scan or scintigram is of some diagnostic value, though, as a rule, it fails to detect cold nodules that are 2 cm. or less in diameter. Larger inactive or cold nodules may show up clearly because on the scintigram they appear paler than the surrounding tissue or, in the case of hyperthyroidism from a toxic nodule itself, the appearance of the nodules on the scintigram will usually be darker than the surrounding tissue that may be relatively suppressed by the excess of thyroxine emanating from the nodule. A nodule that is producing hyperthyroidism is quite unlikely to be carcinoma.
If carcinoma is suspected and the nodule is cold, then there is a greater likelihood of the presence of carcinoma than there would be otherwise. It must not be assumed that the presence of hyperthyroidism excludes the presence. . .