[Endemic goiter in a non-goitrogenic country]

Although goiter is not endemic in Israel, an iodine-rich country due to its bordering on the Mediterranean, we see many adults with massive goiters among immigrants from Afro-Asian and eastern European countries. 702 thyroidectomies were performed between January 1986 and March 1993 and 39 consecutive cases of goiter were studied. The patients ranged in age from 32-83 years (mean, 48); the female/male ratio was 36/3. There were 15 cases (13%) of thyroid carcinoma. In 1 case hyperthyroidism was diagnosed and treated preoperatively (3%) and in 2 others subclinical hypothyroidism was found (5%). The cervical approach was used, including cases with substernal extension. In only 1 was sternal splitting necessary. In our experience enlarged nodular goiter, with or without substernal extension, should be operated before symptoms of tracheal pressure develop and to avoid the risk of neglected malignancy hidden in an enlarged thyroid.