Some Surgical Problems of Nontoxic Goiter*

TODAY interest centers predominantly in the experimental studies which are adding to our knowledge of the physiology of the thyroid and the therapy of its diseases, yet practical problems still arise in the management of these conditions, especially as they are related to surgery of the gland. To the surgeon falls the lot of making important practical decisions about treatment, which are modified by the knowledge being acquired from laboratory and clinical studies. Nontoxic goiter is a very common disease. Partial thyroidectomy for this condition is one of the operations most frequently performed. It is because it is so important for a doctor to be able to determine with discrimination and accuracy those patients who should be subjected to surgery that a discussion of this matter is thought to be worthwhile. The removal of goiters which produce or threaten tracheal obstruction, or those which are large and unsightly, presents technical problems only. There is no question about the indication for surgery in these cases. Goiters which are obviously highly malignant and rapidly growing present their own problems and these are generally concerned with the complications and management of terminal care. Surgery has little to offer and if attempted, may lead to greater difficulties or actually to disaster. There is no need to discuss these problems here. For the surgeon, the principal problems presented by the nontoxic goiter deal with i) diagnosis, ii) surgical measures having as their object prophylaxis against thyroid cancer, iii) the detection of the so-called “benign” forms of malignant neoplasms and iv) the surgical treatment of these neoplasms.