endocrine and metabolic disorders
Simple Nontoxic Goiter
Treatment of Simple Nontoxic Goiter
Depends on cause In iodine-deficient areas, the following eliminate iodine deficiency: Iodine supplementation of salt Oral administration of iodized oil Intramuscular administration of iodized oil yearly Iodination of water, crops, or animal fodder Goitrogens(eg, cassava, broccoli, cauliflower, cabbage) being ingested should be stopped. In other instances, suppression of the hypothalamic-pituitary axis with thyroid hormone blocks thyroid-stimulating hormone (TSH) production (and hence stimulation of the thyroid). Moderate doses oflevothyroxine(100 to 150 mcg orally once a day depending on the serum TSH) are useful in younger patients to reduce the serum TSH to the low-normal range. Levothyroxineis contraindicated in older patients with nontoxic nodular goiter, because these goiters rarely shrink and may harbor areas of autonomy so thatlevothyroxinetherapy can result in hyperthyroidism. Large goiters occasionally require surgery or iodine-131 to shrink the gland enough to prevent interference with respiration or swallowing or to correct cosmetic problems. 