Brown M. Dobyns

Natural history of thyroid abnormalities: Prevalence, incidence, and regression of thyroid diseases in adolescents and young adults

PURPOSE This study reports the prevalence, incidence, and regression of thyroid abnormalities in a population observed from adolescence to adulthood. PATIENTS AND METHODS Examinations for thyroid abnormalities were performed in 4,819 school-age children, ages 11 to 18, in 1965 to 1968; two thirds of this original cohort (3,121) were re-examined 20 years later (1985 to 1986). Each subject with a thyroid abnormality detected by physical examination was studied by means of a series of re-examinations, and tests of thyroid function, imaging, and biopsy to determine the exact nature of the thyroid abnormality. RESULTS In the initial examinations (1965 to 1968), 185 thyroid abnormalities were found (3.7%). Diffuse hypertrophy with normal function (adolescent goiter) was the most common abnormality (19.3/1,000); 12.7/1,000 had chronic lymphocytic thyroiditis, and 4.6/1,000 had thyroid nodules, including two papillary carcinomas. Hyperthyroidism or hypothyroidism was found in 1.9/1,000. In the follow-up examinations in 1985 to 1986, 298 subjects had thyroid abnormalities (10.5%), of whom 81 (28.7/1,000) had simple goiters, 145 (51.3/1,000) had chronic thyroiditis, 45 (15.9/1,000) had hypothyroidism, 11 (3.9/1,000) had hyperthyroidism, and 66 (23.2/1,000) had nodules, which included 10 carcinomas. Of the 92 subjects with simple or adolescent goiter in 1965 to 1968, 60% were normal by 1985 to 1986, 20% were unchanged, and a few had developed thyroiditis (10%) or colloid goiters (3.0%). Of 61 subjects with thyroiditis, 27% had become normal, 33% remained unchanged, and 33% had become hypothyroid. Of the 22 subjects with thyroid nodules, two had complete disappearance of the nodules, and three had nodules considered to be variants of normal. The others exhibited a variety of nodular pathologic conditions. CONCLUSIONS The natural history of thyroid disorders, including simple goiter, chronic thyroiditis, hyperthyroidism, hypothyroidism, and nodular diseases of the thyroid, indicates they are dynamic and changeable in form, function, appearance, and disappearance.

Thyroid disease in children. A survey of subjects potentially exposed to fallout radiation

Abstract We found no significant difference in any type of thyroid disease between children in Utah and Nevada exposed to fallout radiation in the 1950s and control groups living in Utah and Arizona at present. Of the 5,179 children surveyed, thyroid abnormalities were found in 201. Adolescent goiter was the most common disorder with a prevalence of 15 per 1,000 for boys and 20 per 1,000 for girls. There were seven cases of hyperthyroidism, and the rates for lymphocytic thyroiditis were 8 and 16 per 1,000 for boys and girls, respectively. Twenty benign neoplasms and two carcinomas of the thyroid were found. Only 6 of the 201 children with thyroid disease knew of their disease prior to our examination. The inapparent thyroid disease discovered in this group of children through meticulous examination may have its counterpart in other populations as well. This study demonstrates the need, therefore, for careful examination of thyroids even in apparently healthy children.