Use and abuse of iodine in the management of goiter

Abstract

The answers to this questionnaire reveal that 96 per cent of the physicians suggest the use of iodine in the form of Lugol's solution (10 drops weekly) or one 10 mg. idostrone tablet weekly, alone or with dessicated thyroid extract in the treatment of colloid goiter. Eighty-eight per cent find it necessary to correct mild diffuse (exophthalmic) goiter by subtotal thyroidectomy, and another 8 per cent suggest surgery if the condition is not cured in a reasonable period of time with iodine medication. The opinion is practically unanimous (99 per cent) that nontoxic nodular (adenomatous) goiter should not be treated with iodine medication. As many as 79 per cent of the physicians agree that the promiscuous administration of iodine produces activation or toxicity in this type of goiter. In toxic goiter, we note the greatest abuse in the use of iodine medication. Almost 90 per cent of the patients treated by goiter surgeons have had previous iodine medication, which produces an increase in the operative risk, and a very definite increase in the morbidity, especially since stage operations are often necessary in order to prevent an increased mortality. Practically all postoperative thyroid crises occur in patients who have had long continued iodine medication before consulting the goiter surgeon.