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Walk the Even Hospital Database by book and chapter — the raw source passages that ground Ask, DDx, and the rest.
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Surgery Significant goiter reduction Rapid decompression of trachea Prompt relief of symptoms Definite histological diagnosis Inpatient High cost Surgical risk Vocal cord paralysis: ~1 percent Hypoparathyroidism: ~1 percent Risk of hypothyroidism dependent of resection Risk of recurrence dependent of resection
131 I Most often outpatient If outpatient: low cost Few subjective side effects Goiter reduction: 50 percent within 1 yr Improves inspiratory capacity in long term Can be repeated successfully Limitation of administrated radioactivity Restricted proximity to other persons Contraceptives needed in fertile women Gradual reduction of the goiter Decreasing effect with increasing size Small risk of acute goiter enlargement Risk of thyroiditis: 3 percent Risk of transition into Graves' disease: 5 percent 1 yr risk of hypothyroidism: 15 to 20 percent Long-term cancer risk unknown L -T 4 Outpatient Low cost May prevent new nodule formation Low efficacy Lifelong treatment Adverse effects (bone, heart) Not feasible when TSH is suppressed Reproduced with permission from: Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev 2003; 24:102. Copyright © 2003 The Endocrine Society.