Changes in thyroid surgery during iodine prophylaxis of endemic goiter.

Abstract

AbstractThe present report is based on 13,778 patients who had thyroid surgery between 1952 and 1980. Until 1971, western Austria was considered an endemic goiter area (school children goiter incidence 50% in 1963), but with the advent of iodized salt in 1963, the goiter incidence has decreased to 13% in preadolescents in recent years. This change in thyroid pathology was accompanied by a decrease in weight of removed thyroids (mean, 125 g→95 g) with a relative increase of hyperthyroid goiters (8.6%→43.6%) and of thyroid cancer in the surgical series (2.6%→6.8%), while the overall rate of interventions decreased only slightly. Surgery for recurrent goiters is rare now (6.2%) while it was considered a problem in previous years (16%). Histological patterns of thyroid cancer have shown a shift to more differentiated, and therefore more treatable, cancer types. The TNM classification has changed also, with 39.1% T2N1M0 cases now versus only 29% in this prognostically better group before 1971. In conclusion, this study indicates that during iodine prophylaxis for endemic goiter, thyroid surgery will retain its significance in the treatment of thyroid disease but that a different therapeutic approach becomes necessary as a result of significant changes in thyroid pathology. Nodular goiters developing under adequate iodine supply require a much more aggressive therapy than those observed in iodine deficient areas.