The treatment of goitre to-day demands the closest
co-operation between Physician, Surgeon and Radiotherapist.
Some cases will be the domain of the Surgeon, others of the
Physician, others of the Radiotherapist, and yet others
a combination of these. Each must have a thorough working
knowledge of the capabilities, limitations and responsibilities
of the others. Their's is the responsibility to educate
present and future general practitioners, who, in almost all
cases, are the first advocates of this patient. In particular there is a need to impress upon the family doctor the importance
of recognising that non-toxic goitres, especially those occurring
in males, are potentially malignant cancers. Advances in the
treatment of carcinoma of the breast have followed the consciousness
of the potential malignancy of all lumps, with consequent earlier
diagnosis. Similar principles with reference to the thyroid
gland are called for.
Theodore Kocher's mortality rate following operation for
simple nodular goitre was eventually as low as 0.5 %. Indeed
in one particular series of 600 cases in 1898, there was but
one death, and that was due to chloroform anaesthesia. The
mortality rate following operation for non -toxic goitre in
Mr. Cameron's series was 0.3 %. Kocher's success in preserving
the recurrent laryngeal nerves and parathyroid glands was at
least equal to that of the surgeon to-day.
The inference is that there can be no substitute for the
precision and deliberateness of technique so splendidly embodied
in Kocher. But where therapeutic success has been dependent
on advances in physiology and biochemistry, themselves often
the product of surgery, the mortality and morbidity of thyroid
disease has been greatly reduced.