This Article Full Text Full Text (PDF) Submit a related Letter to the Editor Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Copyright Permission Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Diehl, L. A. Search for Related Content PubMed PubMed Citation Articles by Diehl, L. A. Related Collections Thyroid

Management of the Nontoxic Multinodular Goiter in Latin America: Comparison with North America and Europe, an Electronic Survey

Serviço de Endocrinologia, Centro de Ciências da Saúde, Universidade Estadual de Londrina (L.A.D., V.G.), Londrina, Paraná, Brazil; Odense University Hospital (S.J.B., L.H.), Odense C, Denmark; Núcleo de Diagnósticos Maringá (C.C.A.), Maringá, Paraná, Brazil; and Serviço de Endocrinologia e Metabologia (SEMPR), Universidade Federal do Paraná (H.G.), Curitiba, Paraná, Brazil

Address all correspondence and requests for reprints to: Dr. Leandro A. Diehl, Departamento de Clínica Médica-Centro de Ciências da Saúde, Universidade Estadual de Londrina, Avenue Robert Koch 60, Londrina, Paraná, Brazil 86.038-350. E-mail: drgaucho{at}yahoo.com.

To assess diagnostic and therapeutic approaches to nontoxic multinodular goiter and to compare them with previously reported American Thyroid Association (ATA) and European Thyroid Association (ETA) surveys, an online questionnaire was distributed to Latin American Thyroid Society (LATS) members. An index case was presented (42-yr-old woman with an enlarged, irregular, nontender, 50- to 80-g thyroid and no clinical suspicion of malignancy or dysfunction), and 11 variations were proposed to evaluate how each alteration would affect management. We obtained 148 responses (response rate, 50%). In the index case, the most used blood tests were TSH (96%), antithyroid peroxidase antibodies (76%), and free T₄ (64%); 5% included a calcitonin assay. Nearly 90% would perform ultrasound, and only 16% used scintigraphy. Fine needle biopsy was indicated by 88%, with ultrasound guidance in 75% of times. For treatment, observation was preferred by 39%, surgery by 28%, levothyroxine by 21%, and radioiodine by 7% (60% with recombinant TSH prestimulation). A suppressed TSH level prompted 45% of the respondents to recommend radioiodine, whereas 70–78% indicated surgery in the presence of a large goiter or suspicion of malignancy. In conclusion, no consensus exists concerning the ideal management of nontoxic goiter among LATS members, in agreement with previous ATA and ETA surveys. Levothyroxine therapy is less used by LATS than by ATA or ETA members, and a more aggressive therapeutic strategy is generally preferred by members of LATS and ETA compared with ATA.

This article has been cited by other articles:

				S. Fast, V. E. Nielsen, S. J. Bonnema, and L. Hegedus Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy Eur. J. Endocrinol., April 1, 2009; 160(4): 517 - 528. [Abstract] [Full Text] [PDF]

				H Gharib, E Papini, and R Paschke Thyroid nodules: a review of current guidelines, practices, and prospects Eur. J. Endocrinol., November 1, 2008; 159(5): 493 - 505. [Abstract] [Full Text] [PDF]

				B. Biondi and D. S. Cooper The Clinical Significance of Subclinical Thyroid Dysfunction Endocr. Rev., February 1, 2008; 29(1): 76 - 131. [Abstract] [Full Text] [PDF]

				Y. Erbil, A. Bozbora, N. Ozbey, H. Issever, F. Aral, S. Ozarmagan, and S. Tezelman Predictive Value of Age and Serum Parathormone and Vitamin D3 Levels for Postoperative Hypocalcemia After Total Thyroidectomy for Nontoxic Multinodular Goiter Arch Surg, December 1, 2007; 142(12): 1182 - 1187. [Abstract] [Full Text] [PDF]

				S. J. Bonnema, V. E. Nielsen, H. Boel-Jorgensen, P. Grupe, P. B. Andersen, L. Bastholt, and L. Hegedus Improvement of Goiter Volume Reduction after 0.3 mg Recombinant Human Thyrotropin-Stimulated Radioiodine Therapy in Patients with a Very Large Goiter: A Double-Blinded, Randomized Trial J. Clin. Endocrinol. Metab., September 1, 2007; 92(9): 3424 - 3428. [Abstract] [Full Text] [PDF]