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تسجيل

Pathogenesis of Non-Toxic Goitre: Natural course of Disease

المؤلف:  Wass, J. A. H., Arlt, W., & Semple, R. K. (Eds.).

المصدر:  Oxford Textbook of Endocrinology and Diabetes

الجزء والصفحة:  3rd edition , p584

2026-05-21

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From the epidemiological data discussed earlier, one might expect an inherent progressive course of nodular thyroid disease. Studies aimed at accurate assessment of the nodules by ultrasonography differ in terms of follow- up period, definition of growth, type of thyroid lesion and the background, in which they are conducted. Moreover, the interobserver variability of long- term studies of nodule volumes is not known. With these caveats in mind, the following observations have been reported: in iodine- sufficient areas, nodule ‘growth’ has been reported in 35% of US patients over a follow- up period of 4.9 to 5.6 years. On long- term follow- up over 15 years in an area of iodine sufficiency, only one- third of benign nodules showed growth as assessed by palpation and ultrasonography compared with the majority of nodules, which remained unchanged or even showed a decrease in size. In Germany, a mean 3- year follow- up of 109 consecutive patients showed a steady and significant (30% volume) increase in nodular size in 50% of patients. In a Danish study, only four (8%) of 45 cold nodules in an area of borderline iodine deficiency showed a change in size (5 mm in diameter), of which only one nodule actually increased and three nodules shrank over a follow- up period of 2 years. Nodule growth was also determined in a 5- year follow- up study from two areas in Italy with mild to moderate iodine deficiency. Significant nodule growth occurred in 153 of 992 patients (15.3%), shrinkage was observed in 13.1% of cases whereas the majority of nodules (69%) exhibited no change in size over the investigated time period. However, nodule growth was significantly linked to patients with multinodular glands. Thus, in an iodine- deficient and - sufficient setting a variable portion, but most likely not all, of nodules will grow, and the speed of growth is highly heterogeneous.