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Submitted on August 28, 2004
Accepted on October 4, 2004
Serviço de Endocrinologia, Centro de Ciências da Saúde, Universidade Estadual de Londrina - CCS/UEL (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; Serviço de Endocrinologia e Metabologia (SEMPR), Universidade Federal do Paraná (H.G.), Curitiba, Paraná, Brazil., For Latin American Thyroid Society (LATS)
* To whom correspondence should be addressed.
Leandro Arthur Diehl, E-mail: drgaucho{at}yahoo.com
To assess diagnostic and therapeutic approaches to nontoxic multinodular goiter and to compare it 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 50-80 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 mostly used blood tests were TSH (96%), TPO-Ab (76%) and free T4 (64%); 5% included calcitonin assay. Nearly 90% would perform ultrasound (US), and only 16% used scintigraphy. Fine-needle biopsy was indicated by 88%, with US guidance in 75% of times. Regarding treatment, observation was preferred by 39%, surgery by 28%, levothyroxine by 21% and radioiodine by 7% (60% with recombinant TSH prestimulation). A suppressed TSH prompted 45% of the respondents to recommend radioiodine, whereas 70-78% indicated surgery in presence of a large goiter or malignancy suspicion. 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 among members of LATS and ETA compared with ATA.
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