{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T14:38:08Z","timestamp":1792247888623,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2002,4,5]],"date-time":"2002-04-05T00:00:00Z","timestamp":1017964800000},"content-version":"vor","delay-in-days":643,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2000,7]]},"abstract":"<jats:sec><jats:title>BACKGROUND AND OBJECTIVE<\/jats:title><jats:p>The optimum management strategy for the patient with a multinodular nontoxic goitre is still a matter of debate. Our aim was to assess the attitudes towards management of such patients throughout Europe by means of a questionnaire.<\/jats:p><\/jats:sec><jats:sec><jats:title>DESIGN<\/jats:title><jats:p>The questionnaire was circulated to all clinician members of the European Thyroid Association (ETA). A case report was followed by diagnostic investigations and choice of therapy in the index case (a 42\u2010year\u2010old woman with an irregular nontender bilaterally enlarged thyroid of 50\u201380\u2003g and no clinical suspicion of malignancy). Eleven variations of the basic case report were proposed in order to evaluate the impact on management of each alteration.<\/jats:p><\/jats:sec><jats:sec><jats:title>SUBJECTS AND METHODS<\/jats:title><jats:p>One hundred and sixty\u2010seven members replied to the letter, and 120 individuals from 22 countries completed the questionnaire (corresponding to approximately two\u2010thirds of the clinical members of the ETA).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>Based on the index case, serum TSH was the routine choice of 100%, and serum free T4\/T4\u2010index was included by 74%. Serum TPO autoantibodies, Tg autoantibodies and calcitonin were measured by 65%, 49% and 32%, respectively. The median number of blood tests used was four (range 1\u201311). Considerable intercountry variations were seen in the preferred imaging methods. Ninety\u2010one percent of the clinicians would use at least one imaging modality. Ultrasound (US) was used by 84%, thyroid scintigraphy by 76%, and both methods by 69%. US had first priority (53% <jats:italic>vs<\/jats:italic>. 19% for scintigraphy). If scintigraphy was performed, fine\u2010needle aspiration cytology was routinely used by 17% (inhomogeneous uptake) and 95% (dominant \u2018cold\u2019 area), and 63% used US\u2010guidance. L\u2010T4 treatment was supported by 52% of the clinicians, iodine supplementation by 4%, radioiodine by 6% and surgery by 10%. In the case of a suppressed serum TSH, radioiodine treatment was preferred by 44%, while surgery was the favoured recommendation in four clinical variations with a large goitre or suspicion of malignancy. Marked differences between the countries were suggested by L\u2010T4 therapy being the dominant treatment in Italy, France and Germany in contrast to the prevailing use of radioiodine in Denmark and a wait and see policy in the UK.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Fundamental differences between European countries exist as regards diagnosis and treatment of the multinodular nontoxic goitre suggesting difficulties in reaching a consensus.<\/jats:p><\/jats:sec>","DOI":"10.1046\/j.1365-2265.2000.01060.x","type":"journal-article","created":{"date-parts":[[2003,3,11]],"date-time":"2003-03-11T10:45:40Z","timestamp":1047379540000},"page":"5-12","source":"Crossref","is-referenced-by-count":88,"title":["Management of the nontoxic multinodular goitre: A European questionnaire study"],"prefix":"10.1111","volume":"53","author":[{"given":"Steen J.","family":"Bonnema","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finn N.","family":"Bennedb\u00e6k","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wilmar M.","family":"Wiersinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laszlo","family":"Heged\u00fcs","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2002,4,5]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1999.00663.x"},{"key":"e_1_2_6_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0140-6736(90)91730-X"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.84.10.3636"},{"key":"e_1_2_6_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1998.8.283"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1998.8.15"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1994.4.107"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.66.773.186"},{"key":"e_1_2_6_9_2","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1300350"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.84.2.756"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1210\/jcem.82.2.3737"},{"key":"e_1_2_6_12_2","doi-asserted-by":"publisher","DOI":"10.1530\/eje.0.1340015"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.82.9.2926"},{"key":"e_1_2_6_14_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.78.4.826"},{"key":"e_1_2_6_15_2","first-page":"725","article-title":"High long term recurrence rate after subtotal thyroidectomy for nodular goitre","volume":"161","author":"R\u00f6jdmark J.","year":"1995","journal-title":"European Journal of Surgery"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199411103311901"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1998.8.83"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0889-8529(05)70240-1"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1089\/thy.1991.1.129"},{"key":"e_1_2_6_20_2","unstructured":"Wesche M.F.T. Tiel V. Buul M.M. Lips P. Smits N.J.&Wiersinga W.M.(1998) A randomized trial comparing L\u2010thyroxine with radio\u2010active iodine in the treatment of sporadic nontoxic goiter. InStudies on thyroid size in health and disease. (Thesis University of Amsterdam)."},{"key":"e_1_2_6_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF02385801"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1046%2Fj.1365-2265.2000.01060.x","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1046%2Fj.1365-2265.2000.01060.x","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1046\/j.1365-2265.2000.01060.x","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,29]],"date-time":"2023-10-29T11:25:25Z","timestamp":1698578725000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1046\/j.1365-2265.2000.01060.x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2000,7]]},"references-count":20,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2000,7]]}},"alternative-id":["10.1046\/j.1365-2265.2000.01060.x"],"URL":"https:\/\/doi.org\/10.1046\/j.1365-2265.2000.01060.x","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2000,7]]}}}