Diagnostiek en therapie bij patiënten met euthyreotisch struma

- Nontoxic goitre is common, even in areas where iodine intake is sufficient.

- The most important symptoms and signs of nontoxic goitre are caused by compression of vital structures in the neck or upper thoracic cavity.

- In any patient with goitre the serum concentration of thyroid-stimulating hormone (TSH) should be measured to detect or exclude clinically inapparent (subclinical) hyper- or hypothyroidism.

- CT and MRI are expensive but very sensitive methods to identify tracheal compression and to determine intrathoracic extension.

- Thyroid ultrasonography and scintigraphy are not routinely indicated.

- Fine-needle aspiration biopsy is indicated in patients with fast-growing nodules and nodules that have a firmer consistency than other nodules within the gland.

- Thyroidectomy is standard therapy for young and otherwise healthy patients, especially when prompt decompression of vital structures is required.

- Radioiodine therapy is an attractive alternative to surgery in older patients, in those with cardiopulmonary disease, and in those with recurrent goitre.

- Thyroxin therapy may be tried in young patients with small, diffuse goitres who have normal serum TSH concentrations.