PubMed · 5997013
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H Steiner. 1966-06-03. [Surgical viewpoints].. https://pubmed.ncbi.nlm.nih.gov/5997013/
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Goitre due to nodular thyroid disease is common. Most patients present with benign disease and are euthyroid at presentation, but careful clinical evaluation (thyroid function tests and fine needle biopsy) is essential to determine appropriate therapy. Thyroid hormone therapy should be reserved for hypothyroid patients and those with Hashimoto's thyroiditis. Iodine supplements are not beneficial. Indications for surgery are a malignant or atypical finding on fine needle biopsy, a recurrent cyst larger than 4 cm in diameter, or a goitre causing obstruction.
Levo-thyroxine has for many years been used after operation for non-toxic goitre to prevent recurrence and postoperative thyroid hypofunction. The philosophy behind prevention was to suppress production of the thyroid stimulating hormone (TSH), which was assumed to be the main growth factor for the thyroid gland. Suppression of the serum-TSH concentration by thyroxine therefore seemed logical. No scientific documentation verifying this assumption has been found in non-endemic goitre areas. Treatment with levo-thyroxine subsequent to goitre surgery is thus only indicated in situations with risk of hypofunction, viz. when only a small thyroid remnant is left.