Conservative treatment and long term prophylactic thyroxine in the prevention of recurrence of multinodular goiter.

It has not been universally agreed upon that there is an optimum treatment for multinodular goiter and that use of thyroxine postoperatively in preventing recurrence is effective. We have studied a group of 185 patients who underwent thyroid gland operations and who were observed for a mean period of 10.25 years. Of these, 171 patients received postoperative thyroxine in a dose of 100 micrograms per day and a small group (14 patients) received no medication. In the group receiving no thyroxine, there were six recurrences, and in the group that received postoperative prophylactic thyroxine, there were nine recurrences, which is statistically significant (p = 0.003 per cent). When recurrences did occur in the thyroxine treated group they were small and easily managed by increasing the dose of thyroxine. No patient who took thyroxine postoperatively continuously underwent a second thyroidectomy. We conclude that, in this series, our policy of resecting only macroscopically pathologic thyroid tissue and prescribing prophylactic postoperative thyroxine is successful in preventing recurrent nodular goiter.