Clinicopathological Study of Endemic Goiter

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  • SUNG TZU-CHI
    Department of Surgery, Juntendo University, School of Medicine.

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  • 地方性甲状腺腫の臨床病理学的研究
  • チホウセイ コウジョウセンシュ ノ リンショウ ビョウリガクテキ ケンキュウ

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Abstract

Five hundreds eighty-six patients with thyroid disease, living on the endemic area in Taiwan, were received thyroidectomy. Clinicopathological studies for 336 cases of endemic goiter of them were performed and summarized as follows : 1) In the total of 336 cases with endemic goiter, sex ratio was 1 : 7.6 (male 39 cases, female 297 cases) with predominance in female. Peak age incidence for female was 20 to 30-year-old, male was 30 to 40-year-old. 2) The more precise clinicopathololgical classification for endemic goiter are Stage 1- Hyperplastic phase, Stage 2-Enlarged phase and Stage 3-Nodular phase. 3) Of the total cases in this study;Stage 1 : Hyperplastic phase, 10 cases (3.0%) Stage 2 : Enlarged phase, 28 cases (8.3%) Stage 3 : Nodular phase, 88.7%; they were single nodule in 62 cases (18.5%) and multiple nodules in 236 cases (70.2%). 4) Thyroid goiter enlarged in correspondence to the clinicopathologic stage. In Stage 3-Nodular phase, there were cases having local compression sign, but no systemic symptoms and biochemical studies were in normal range. 5) Histopathologically, diffuse hyperplastic finding is characteristic for Stage 1, mild parenchymal enlargement of the thyroid gland may be seen, this is the “Hyperplastic Phase”. Stage 2, follicles are filled with colloid diffusely, scattering hyperplastic pictures and less mild involution may be seen in some place, but marked colloidal enlargement of the thyroid gland is characteristic, this is “Enlarged Phase”. Stage 3 is “Nodular Phase”, nodules were varing in size, single or multiple in number, histologically they show marked involutional changes. 6) In Stage 1, the lesions almost involved in both lobes; in Stage 2, equally in both lobes and single lobe; in Stage 3, more frequently in single lobe. The right lobe was larger than left lobe when the lesions involved in both lobes, but no difference in size involving in single lobe. 7) According to histopathological changes, clinical course and effects of iodine therapy, endemic goiter is progressing as stated above, and Stage 3 is the final phase. 8) There are 9.4% cases of Stage 3 associated with other throid disease. Secondary hyperthyroidism, 12 cases (4.03%), adenoma, 4 cases (1.34%), thyroid carcinoma, 12 cases (4.3%) these lesions are in close relation to the site of the nodule. 9) The effects of iodine therapy was predominantly in Stage 1, but non-effective in Stage 2 and Stage 3. Therefore, surgical treatment is considerable for Stage 2 and Stage 3. 10) Post-operative course of these 336 cases with endemic goiter after subtotal thyroidectomy were very well. Only 2 of them had mild hypothyroidism after the operation.

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