Treatment of goitre to-day: six cases of goitre seen in wards 15 and 16 of the Royal Infirmary of Edinburgh during April and May 1967

Abstract

The treatment of goitre to-day demands the closest co-operation between Physician, Surgeon and Radiotherapist. Some cases will be the domain of the Surgeon, others of the Physician, others of the Radiotherapist, and yet others a combination of these. Each must have a thorough working knowledge of the capabilities, limitations and responsibilities of the others. Their's is the responsibility to educate present and future general practitioners, who, in almost all cases, are the first advocates of this patient. In particular there is a need to impress upon the family doctor the importance of recognising that non-toxic goitres, especially those occurring in males, are potentially malignant cancers. Advances in the treatment of carcinoma of the breast have followed the consciousness of the potential malignancy of all lumps, with consequent earlier diagnosis. Similar principles with reference to the thyroid gland are called for.Theodore Kocher's mortality rate following operation for simple nodular goitre was eventually as low as 0.5 %. Indeed in one particular series of 600 cases in 1898, there was but one death, and that was due to chloroform anaesthesia. The mortality rate following operation for non -toxic goitre in Mr. Cameron's series was 0.3 %. Kocher's success in preserving the recurrent laryngeal nerves and parathyroid glands was at least equal to that of the surgeon to-day.The inference is that there can be no substitute for the precision and deliberateness of technique so splendidly embodied in Kocher. But where therapeutic success has been dependent on advances in physiology and biochemistry, themselves often the product of surgery, the mortality and morbidity of thyroid disease has been greatly reduced.