Results from an observational study on general practitioners' and endocrinologists' medical practice for the management of simple goiter in France
Caron Philippe1,2 & Landron Frederic1,2
The primary objective of this observational study was to determine the medical practice for the management of simple goiter in France from a representative sample of general practitioners (GPs) and endocrinologists (ENDOs). As secondary objective, this study reported the incidence rate of simple goiter, toxic and non-toxic nodular goiters in France.
Four hundred and sixty-nine general practitioners and 195 endocrinologists participated in the study. Eighty percent of GPs were men and 70% of ENDOs were women. For both groups of physicians (GPs versus ENDOs), the circumstances of diagnosis of simple goiter in adults were: clinical examination (39.4 vs 20.6%), physical signs (20.6 vs 12.1%) and functional signs (13.8 vs 7.3%).
The clinical history almost systematically showed a family or autoimmune disease history (86.1 vs 100%), a smoking habit (69.2 vs 78.5%) and a treatment with amiodarone (70.9 vs 76.4%). However, the iodine intake or eating habits were less often asked (24.2 vs 15.4%). A treatment with lithium (31.6 vs 63.1%) and the notion of previous injection of iodine-containing contrast media (39.1 vs 62.6%) was more often asked by ENDOs than by GPs.
The clinical examination systematically included the palpation of the lower cervical region which determined the goiter consistence and the presence of nodules in more than 90% cases. However, the neck size and goiter size were more seldom measured.
Among the additional investigations (TSH, free T4, Ac anti TPO, ultrasonography, scintigraphy), TSH levels were systematically assayed, an ultrasonography was requested by more than 97% of physicians, and 77.4% of GPs performed a scintigraphy versus 46.9% of endocrinologists.
Regarding their clinical practice, 28.6% of GPs systematically refer their patients with simple goiter to endocrinologists, and the latter see 53% of the patients referred to by GPs, occupational physicians or PMI (Mother and Child Protection centers) and gynecologists. 74.1% of GPs and 96.9% of ENDOs initiated a treatment. When a medical treatment was prescribed, it was levothyroxine (89 vs 92%). The objective of TSH levels was of 2 mIU/l for GPs and 1 mIU/l for ENDOs. Finally, 67.2% of GPs and 56.7% of endocrinologists may ask their patients to undergo surgery.
The incidence rate of simple goiter was 0.45% for GPs and 3.10% for ENDOs. It especially concerned women, 80.5% for GPs including 6% of pregnant or lactating women and 75.3% for endocrinologists including 16.8% of pregnant or lactating women. Non-toxic nodular goiter reached an incidence rate of 9% for endocrinologists.
In conclusion, the study confirms the role of endocrinologists as referent physicians for the management of simple goiter in France, and especially for pregnant women and teenagers.