{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T14:39:10Z","timestamp":1792247950229,"version":"4.4.0"},"reference-count":40,"publisher":"Bioscientifica","issue":"4","license":[{"start":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T00:00:00Z","timestamp":1771200000000},"content-version":"vor","delay-in-days":4142,"URL":"https:\/\/www.karger.com\/Services\/SiteLicenses"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2014,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Background: There is a lack of consensus in Europe regarding the management of patients with benign goitre. The object of this study was to find out the long-term results of recommending to patients with clinically and cytologically benign non-toxic goitres not to be operated. Methods: 980 patients were initially referred for surgical evaluation due to non-toxic goitre, 508 of whom underwent directly thyroidectomy. The remaining 473 patients (median age 56 years) were not operated and followed prospectively for a median period of 145 months. Results: During follow-up, 38% of the 473 patients were re-referred to the surgeon for a new evaluation due to different complaints, mainly growth of the goitre and\/or worsening of local symptoms. 102 of the 473 patients (22%) had surgery and 27 (5.7%) developed thyrotoxicosis. 14 patients (3%) were diagnosed with thyroid carcinoma, 4 (0.46%) of whom (all elderly women) died of the disease. Conclusions: In patients with non-toxic goitre in whom surgery is not deemed necessary at initial evaluation, a conservative approach is reasonable. There is, however, a small risk for the development of aggressive carcinomas, and a fourth of the patients are operated at a median follow-up of 12 years.<\/jats:p>","DOI":"10.1159\/000367845","type":"journal-article","created":{"date-parts":[[2014,10,15]],"date-time":"2014-10-15T02:59:53Z","timestamp":1413341993000},"page":"240-244","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-17","source":"Crossref","is-referenced-by-count":1,"title":["A Conservative Approach Is Reasonable in Patients with Non-Toxic Goitre: Results from an Observational Study during 30 Years"],"prefix":"10.1530","volume":"3","author":[{"given":"Johannes","family":"J\u00e4rhult","sequence":"first","affiliation":[{"name":"1Department of Surgery, Highland Hospital, Eksj\u00f6, Sweden"},{"name":"2Department of Surgery, County Hospital Ryhov, J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ramtin","family":"Vedad","sequence":"additional","affiliation":[{"name":"2Department of Surgery, County Hospital Ryhov, J\u00f6nk\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2014,10,15]]},"reference":[{"key":"2026070712452279300_ref1","doi-asserted-by":"crossref","unstructured":"Kilpatrick R, Milne JS, Rushbrooke M, Wilson ESB, Wilson GM: A survey of thyroid enlargement in two general practices in Great Britain. Br Med J 1963;i:29-34.10.1136\/bmj.1.5322.2914032624","DOI":"10.1136\/bmj.1.5322.29"},{"key":"2026070712452279300_ref2","doi-asserted-by":"crossref","unstructured":"Tunbridge WM, Evered DC, Hall R, Appleton D, Brewis M, Clark F, Grimley Evans J, Young E, Bird T, Smith PA: The spectrum of thyroid disease in the community: The Whickham Survey. Clin Endocrinol 1977;7:481-493.10.1111\/j.1365-2265.1977.tb01340.x598014","DOI":"10.1111\/j.1365-2265.1977.tb01340.x"},{"key":"2026070712452279300_ref3","unstructured":"Hampel R, Kuhlberg T, Klein K, Jerichow JU, Pichmann EG, Clausen V, Schmidt I: Strumapr\u00e4valenz in Deutschland is gr\u00f6sser als bisher angenommen. Med Klinik 1995;90:342-349."},{"key":"2026070712452279300_ref4","doi-asserted-by":"crossref","unstructured":"Petersen K, Lindstedt G, Lundberg P-A, Bengtsson C, Lapidus L, Nystr\u00f6m E. Thyroid disease in middle-aged and elderly Swedish women: thyroid-related hormones, thyroid dysfunction and goitre in relation to age and smoking. J Intern Med 1991;229:407-414.10.1111\/j.1365-2796.1991.tb00367.x2040866","DOI":"10.1111\/j.1365-2796.1991.tb00367.x"},{"key":"2026070712452279300_ref5","unstructured":"Borup Christensen S, Ericsson UB, Janzon L, Tibblin S, Trell E. The prevalence of thyroid disorders in a middle-aged female population, with special reference to the solitary thyroid nodule. Acta Chir Scand 1984;150:13-19.6702389"},{"key":"2026070712452279300_ref6","doi-asserted-by":"crossref","unstructured":"Reiners C, Wegscheider K, Schicha H, Theissen P, Vaupel R, Wrbitsky R, Schumm-Draeger PM: Prevalence of thyroid disorders in the working population of Germany: ultrasonography screening in 96,278 unselected employees. Thyroid 2004;14:926-932.10.1089\/thy.2004.14.92615671771","DOI":"10.1089\/thy.2004.14.926"},{"key":"2026070712452279300_ref7","doi-asserted-by":"crossref","unstructured":"Guth S, Theune U, Aberle J, Galoch A, Bamberger CM: Very high prevalence of thyroid nodules detected by high frequency (13 MHz) ultrasound examination. Eur J Clin Invest 2009;39:699-706.10.1111\/j.1365-2362.2009.02162.x19601965","DOI":"10.1111\/j.1365-2362.2009.02162.x"},{"key":"2026070712452279300_ref8","doi-asserted-by":"crossref","unstructured":"Parker JLW, Ratcliffe JG, Alexander WD: Sporadic non-toxic goitre. A long-term follow-up of 36 patients. Acta Endocrinol (Copenh) 1977;85:497-507.10.1530\/acta.0.085049768654","DOI":"10.1530\/acta.0.0850497"},{"key":"2026070712452279300_ref9","doi-asserted-by":"crossref","unstructured":"Vanderpump MPJ, Tunbridge WMG, French JM, Appleton D, Bates D, Clark F, Grimley Evans J, Hasan DN, Rodgers H, Tunbridge F, Young ET: The incidence of thyroid disorders in the community: a twenty-year follow-up of the Whickham Survey. Clin Endocrinol 1995;43:55-68.10.1111\/j.1365-2265.1995.tb01894.x7641412","DOI":"10.1111\/j.1365-2265.1995.tb01894.x"},{"key":"2026070712452279300_ref10","doi-asserted-by":"crossref","unstructured":"Quadbeck B, Pruellage J, Roggenbuck U, Hirche H, Janssen OE, Mann K, Hoermann R: Long-term follow-up of thyroid nodule growth. Exp Clin Endocrinol Diabetes 2002;110:348-354.10.1055\/s-2002-3499212397534","DOI":"10.1055\/s-2002-34992"},{"key":"2026070712452279300_ref11","doi-asserted-by":"crossref","unstructured":"Berghout A, Wiersinga WM, Smits NJ, Touber JL: Interrelationships between age, thyroid volume, thyroid nodularity, and thyroid function in patients with sporadic nontoxic goiter. Am J Med 1990;89:602-608.10.1016\/0002-9343(90)90178-G2239979","DOI":"10.1016\/0002-9343(90)90178-G"},{"key":"2026070712452279300_ref12","doi-asserted-by":"crossref","unstructured":"Erdogan MF, Gursoy A, Erdogan G: Natural course of benign thyroid nodules in a moderately iodine-deficient area. Clin Endocrinol (Oxf) 2006;65:767-771.10.1111\/j.1365-2265.2006.02664.x17121528","DOI":"10.1111\/j.1365-2265.2006.02664.x"},{"key":"2026070712452279300_ref13","doi-asserted-by":"crossref","unstructured":"Winbladh A, J\u00e4rhult J: Fate of the non-operated, non-toxic goitre in a defined population. Br J Surg 2008;95:338-343.10.1002\/bjs.597717929233","DOI":"10.1002\/bjs.5977"},{"key":"2026070712452279300_ref14","doi-asserted-by":"crossref","unstructured":"Vander JB, Gaston EA, Dawber TR: The significance of nontoxic thyroid nodules. Final report of a 15-year study of the incidence of thyroid malignancy. Ann Intern Med 1968;69:537-540.10.7326\/0003-4819-69-3-5375673172","DOI":"10.7326\/0003-4819-69-3-537"},{"key":"2026070712452279300_ref15","doi-asserted-by":"crossref","unstructured":"Liel Y, Ariad S, Barchana M: Long-term follow-up of patients with initially benign thyroid fine-needle aspirations. Thyroid 2001;11:775-778.10.1089\/1050725015248462811525271","DOI":"10.1089\/10507250152484628"},{"key":"2026070712452279300_ref16","unstructured":"Mazzawi SJ, Rosen G, Luboshitsky R, Dharan M: Management of benign thyroid nodules based on the findings of fine-needle aspiration. J Otorhinol 2000;29:95-97.10819107"},{"key":"2026070712452279300_ref17","doi-asserted-by":"crossref","unstructured":"Elte JWF, Bussemaker JK, Haak A: The natural history of euthyroid multinodular goitre. Postgrad Med J 1990;66:186-190.10.1136\/pgmj.66.773.1862114018","DOI":"10.1136\/pgmj.66.773.186"},{"key":"2026070712452279300_ref18","doi-asserted-by":"crossref","unstructured":"Wiener J: Long-term follow-up in untreated Plummer's disease (autonomous goiter). Clin Nucl Med 1987;12:198-203.3829547","DOI":"10.1097\/00003072-198703000-00008"},{"key":"2026070712452279300_ref19","doi-asserted-by":"crossref","unstructured":"Kuma K, Matsuzuka F, Yokozawa T, Miyauchi A, Sugawara M: Fate of untreated benign thyroid nodules: results of long-term follow-up. World J Surg 1994;18:495-499.10.1007\/BF003537457725734","DOI":"10.1007\/BF00353745"},{"key":"2026070712452279300_ref20","doi-asserted-by":"crossref","unstructured":"Rios A, Rodriguez JM, Canteras M, Galindo PJ, Balsalobre MD, Parrilla P: Risk factors for malignancy in multinodular goitres. Eur J Surg Oncol 2004;30:58-62.10.1016\/j.ejso.2003.10.02114736524","DOI":"10.1016\/j.ejso.2003.10.021"},{"key":"2026070712452279300_ref21","doi-asserted-by":"crossref","unstructured":"Cole WH. Incidence of carcinoma of the thyroid in nodular goiter. Semin Surg Oncol 1991;7:61-63.10.1002\/ssu.29800702032034940","DOI":"10.1002\/ssu.2980070203"},{"key":"2026070712452279300_ref22","unstructured":"McCall A, Jarosz H, Lawrence AM, Paloyan E: Surgery 1986;100:1128-1132.3787469"},{"key":"2026070712452279300_ref23","unstructured":"Taneri F, Kurukahvecioglu O, Ege B, Yilmaz U, Tekin E, Cifter C, Onuk E: Prospective analysis of 518 cases with thyroidectomy in Turkey. Endocr Regul 2005;39:85-90.16468230"},{"key":"2026070712452279300_ref24","doi-asserted-by":"crossref","unstructured":"Giles Y, Boztepe H, Terzioglu T, Tezelman S: The advantage of total thyroidectomy to avoid reoperation for incidental thyroid cancer in multinodular goiter. Arch Surg 2004;139:179-182.10.1001\/archsurg.139.2.17914769577","DOI":"10.1001\/archsurg.139.2.179"},{"key":"2026070712452279300_ref25","doi-asserted-by":"crossref","unstructured":"Pelizzo MR, Bernante P, Toniato A, Fassina A: Frequency of thyroid carcinoma in a recent series of 539 consecutive thyroidectomies for multinodular goiter. Tumori 1997;83:653-655.9267482","DOI":"10.1177\/030089169708300305"},{"key":"2026070712452279300_ref26","doi-asserted-by":"crossref","unstructured":"Belfiore A, LaRosa GL, LaPorta GA, Giuffrida D, Milazzo G, Lupo L, Regalbuto C, Vigneri R: Cancer risk in patients with cold thyroid nodules: relevance of iodine intake, sex, age, and multinodularity. Am J Med 1992;93:363-369.10.1016\/0002-9343(92)90164-71415299","DOI":"10.1016\/0002-9343(92)90164-7"},{"key":"2026070712452279300_ref27","doi-asserted-by":"crossref","unstructured":"Koh KBH, Chang KW. Carcinoma in multinodular goitre. Br J Surg 1992;79:266-267.10.1002\/bjs.18007903281555099","DOI":"10.1002\/bjs.1800790328"},{"key":"2026070712452279300_ref28","doi-asserted-by":"crossref","unstructured":"Cichori W, Walencik G, Gierczak W, Aksedowski K, Bucki J, Cichori S: Total thyroidectomy for multinodular goiter. Possibility of implementation in a district hospital. Pol Przegl Chir 2013;85:53-57.10.2478\/pjs-2013-001023585205","DOI":"10.2478\/pjs-2013-0010"},{"key":"2026070712452279300_ref29","doi-asserted-by":"crossref","unstructured":"Negro R, Piana S, Ferrari M, Ragazzi M, Gardini G, Asioli S, Pacchioni D, Riganti F, Valcavi R: Assessing the risk of false-negative fine-needle aspiration cytology and of incidental cancer in nodular goiter. Endocr Pract 2013;19:444-450.10.4158\/EP12271.OR23337148","DOI":"10.4158\/EP12271.OR"},{"key":"2026070712452279300_ref30","doi-asserted-by":"crossref","unstructured":"Luo J, McManus C, Chen H, Sippel RS: Are there predictors of malignancy in patients with multinodular goiter? J Surg Res 2012;174:207-210.10.1016\/j.jss.2011.11.103522341348","DOI":"10.1016\/j.jss.2011.11.1035"},{"key":"2026070712452279300_ref31","unstructured":"Pradhan GB, Shrestha R, Shrestha S, Neupane J, Bhattachan CL: The incidence of thyroid carcinoma in multinodular goiter: prospective study. Nepal Med Coll J 2011;13:169-171.22808807"},{"key":"2026070712452279300_ref32","doi-asserted-by":"crossref","unstructured":"Frates MC, Benson CB, Doubilet PM, Kunreuther E, Contreras M, Cibas ES, Orcutt J, Moore FD Jr, Larsen PR, Marqusee E, Alexander EK: The frequency of carcinomas is similar in patients with one thyroid nodule and those with multiple nodules. J Clin Endocrinol Metab 2006;91:3411-3417.","DOI":"10.1210\/jc.2006-0690"},{"key":"2026070712452279300_ref33","doi-asserted-by":"crossref","unstructured":"Harrach HR, Franssila KO, Wasenius W-M: Occult papillary carcinoma in Finland: a \u2018normal' finding in Finland: a systematic autopsy study. Cancer 1985;56:531-538.10.1002\/1097-0142(19850801)56:3&lt;531::AID-CNCR2820560321&gt;3.0.CO;2-32408737","DOI":"10.1002\/1097-0142(19850801)56:3<531::AID-CNCR2820560321>3.0.CO;2-3"},{"key":"2026070712452279300_ref34","doi-asserted-by":"crossref","unstructured":"Bondesson L, Ljungberg O: Occult thyroid carcinoma at autopsy in Malm\u00f6, Sweden. Cancer 1981;47:319-323.10.1002\/1097-0142(19810115)47:2&lt;319::AID-CNCR2820470218&gt;3.0.CO;2-A7459819","DOI":"10.1002\/1097-0142(19810115)47:2<319::AID-CNCR2820470218>3.0.CO;2-A"},{"key":"2026070712452279300_ref35","doi-asserted-by":"crossref","unstructured":"Nielsen B, Zetterlund B: Malignant thyroid tumours at autopsy in a Swedish goitreous population. Cancer 1985;55:1041-1043.10.1002\/1097-0142(19850301)55:5&lt;1041::AID-CNCR2820550519&gt;3.0.CO;2-R3967189","DOI":"10.1002\/1097-0142(19850301)55:5<1041::AID-CNCR2820550519>3.0.CO;2-R"},{"key":"2026070712452279300_ref36","doi-asserted-by":"crossref","unstructured":"Ihre Lundgren C, Hall P, Ekbom A, Frisell J, Zedenius J, Dickman PW: Incidence and survival of Swedish patients with differentiated thyroid cancer. Int J Cancer 2003;106:569-573.10.1002\/ijc.1127512845654","DOI":"10.1002\/ijc.11275"},{"key":"2026070712452279300_ref37","unstructured":"Demeter JG, DeJong SA, Lawrence AM, Paloyan E: Anaplastic thyroid carcinoma: risk factors and outcome. Surgery 1991;110:956-963.1745983"},{"key":"2026070712452279300_ref38","doi-asserted-by":"crossref","unstructured":"Bennedbaek FN, Perrild H, Heged\u00fcs L: Diagnosis and treatment of the solitary thyroid nodule. Clin Endocrinol 1999;50:357-363.10.1046\/j.1365-2265.1999.00663.x10435062","DOI":"10.1046\/j.1365-2265.1999.00663.x"},{"key":"2026070712452279300_ref39","doi-asserted-by":"crossref","unstructured":"Bonnema SJ, Bennedbaek FN, Wiersinga WM, Hegedus L: Management of the nontoxic multinodular goitre: a European questionnaire study. Clin Endocrinol 2000;53:5-12.10.1046\/j.1365-2265.2000.01060.x10931075","DOI":"10.1046\/j.1365-2265.2000.01060.x"},{"key":"2026070712452279300_ref40","doi-asserted-by":"crossref","unstructured":"Bhagat MC, Dhaliwal SS, Bonnema SJ, Heged\u0171s L, Walsh JP: Differences between endocrine surgeons and endocrinologists in the management of non-toxic multinodular goitre. Br J Surg 2003;90:1103-1112.10.1002\/bjs.417112945078","DOI":"10.1002\/bjs.4171"}],"container-title":["European Thyroid Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.bioscientifica.com\/etj\/article-pdf\/3\/4\/240\/29058\/etj367845.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/journals.bioscientifica.com\/etj\/article-pdf\/3\/4\/240\/29058\/etj367845.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T16:58:55Z","timestamp":1783443535000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.bioscientifica.com\/etj\/article\/3\/4\/240\/3961\/A-Conservative-Approach-Is-Reasonable-in-Patients"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,10,15]]},"references-count":40,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2014,12,1]]}},"URL":"https:\/\/doi.org\/10.1159\/000367845","relation":{},"ISSN":["2235-0802","2235-0640"],"issn-type":[{"value":"2235-0802","type":"electronic"},{"value":"2235-0640","type":"print"}],"subject":[],"published":{"date-parts":[[2014,10,15]]}}}