Endocrine Abstracts

We report the management of 16 predominately elderly patients (12 female: 2 male; mean age at presentation 73.8 years, range 48 to 85 years) presenting with massive goitres. Seventy-five percent had significant co-morbidities. Fifteen had multinodular goitres and 1 Reidel’s thyroiditis. Four goitres were confined to the neck; 6 were intra-thoracic and 6 had both neck and intra-thoracic goitres. Five had symptoms of compression; 9 were thyrotoxic and 2 hypothyroid. Mean follow-up was 3.2 years (range 1 to 7 years).

Six were treated with long-term carbimazole; 3 underwent thyroidectomy (1 being a lobectomy) and 2 received radioactive iodine therapy (2 doses of 400 mBQ each).

Follow-up (>2 studies) was by serial ultrasound scans in 4; CT scans in 8 and flow-loop spirometry in 7. On CT scan 5 had significant tracheal compression but only 1 goitre increased significantly in size. Flow-loop spirometry did not change.

The majority had non-progressive goitres requiring serial monitoring only. However, indications for surgical or radio-iodine treatment included symptoms, thyrotoxicosis, increased goitre size, tracheal compression and the suspicion of malignancy.