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Index of Q&As with Dr. David Derry
Topic: Goiters
A Reader Writes:
"Is there any new information on goiters? I have an enlarged thyroid and have been dealing with it for about 12yrs. I have had it tested for cancer a number of times and it always comes up benign. In the last year it has gotten larger and although I didn't want to take it out I am beginning to consider that option. Do you know of any new treatment to shrink it down? I would really rather go that way instead of an operation."
David Derry Responds:
Dear Patient
The most common cause of goitre (any swelling of the thyroid gland) is low dietary iodine intake over a long period of time. Depending on your age there have been in the past two non surgical ways to try and get it to go down. If you are a teenager then iodine will often make it go down by itself. Whereas if you are an adult thyroid hormone will sometimes make it go down but not all the time.
In a 1962 study on 80 patients with goiters 15 of the 90 disappeared completely with thyroid treatment. Thirty nine of the 80 had more than a 50% reduction in size. All the others were considered failures even when the patient felt the goiter was smaller. Most reductions of the thyroid gland took at least six months. Dosages of thyroid hormone used then were higher than what is used now because of the introduction of lab tests and the TSH in 1975. In this same study they compared the use of desiccated thyroid and triiodothyronine(T3). They found that whole thyroid extract (desiccated thyroid) was more effective than the T3.
If it doesn't respond to either of those regimes, then you may be stuck. Generally this study recommended surgery for the non-responders. If it keeps growing then it more likely need to be taken out. There is no real danger from it but it is annoying and conspicuous so nobody likes to have a goitre. I know of nothing else which will shrink it down. Occasionally a goiter will cause some symptoms of pressure in the throat
in which case surgery is indicated again. Hope this information helps.
David
1. N. G. Schneeberg, T. J. Stahl, G. Maldia, and H. Menduke. Regression of goiter by whole thyroid or triiodothyronine. Metabolism 11:1054-60, 1962.
About Dr. Derry:
Dr. Derry is no longer practicing medicine.
These answers are personal opinions. Please discuss any ideas you get with your physician.
Born in 1937, I am at the cutting edge of the war baby boom. With one exception the baby boomers tend to do what I do in large numbers about ten years later. The exception was that after finishing my internship at the Toronto General Hospital in 1963, as I had planned, I started a PhD in biochemistry at the Montreal Neurological Institute at McGill University in Montreal. After completing my PhD, I was hired by the Department of Pharmacology at the University of Toronto to teach and do research. Within a short time I became a Medical Research Council Scholar, which meant the Medical Research Council of Canada paid my salary to do research. Domestic rearrangements suddenly placed five children between the ages of 5 and 9 under my care. I abandoned my research career and took all five children, a new wife and dog out west to Victoria British Columbia.
My aim in 30 years of General Practice (an honor and a privilege) was to learn carefully and persistently how to listen to the patient. This is the one area of medical research that has gone almost totally un-examined. Sir William Osler, who I feel was the greatest physician of all time, said: if you listen to the patient they will usually give you the diagnosis and if you listen even more carefully they will likely indicate the best treatment for them. Gradually with the help of multiple self-development courses over the years I learned to listen by just getting my ego out of the way. From my patients I learned everything. Because of the arrival of effective treatments with potential side-effects, in 1945 the out-dated Hippocratic oath of “do no harm” was replaced with a new principle of ethical patient care namely “Consider first the well-being of the patient.” Combining extensive medical-literature reading with what I learned daily from patients clarified which approaches and treatments assured the “well-being of the patient.”
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