COMMENTARY

Does a Goiter Always Require Surgery?

Albert Lowenfels, MD

Disclosures

May 15, 2008

Fate of the non-operated, non-toxic goitre in a defined population

Winbladh A, Järhult J
Br J Surg. 2008;95:338-343

Does every patient with a benign goiter need surgery? To answer this question, the study authors reviewed data on 261 patients (median age, 56 years) who, at the time of clinical examination or after fine-needle aspiration (233 patients), did not wish or appear to need surgery. During a median follow-up period of 130 months, 36% of these patients had an additional surgical evaluation. Of the original group, 57 underwent surgery; 5 patients were diagnosed with thyroid cancer; and 13 developed thyrotoxicosis.

Within this group, 95% of the patients were satisfied with a "watch and wait" policy, even though about 20% eventually required surgery. The risk of developing thyroid cancer over a 10-year period was low -- less than 2% -- but 3 of the 5 elderly patients with thyroid cancer died. This report confirmed that most patients with a clinically and pathologically benign goiter will not require surgery. However, a real -- even if minimal -- risk for thyroid cancer exists for patients in the "watchful waiting" group.

Abstract

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