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==Overview==
==Overview==
Pharmacologic medical therapy for goiter involves normalizing hormone levels and treating the [[inflammation]]. Treatment regimen involves [[Lugol's iodine]], [[antithyroid drugs]] and [[β-adrenergic blockers]]. In some cases, [[radioactive iodine]] may be used to treat an overactive thyroid gland.
Pharmacologic medical [[therapy]] for goiter involves normalizing [[thyroid hormone]] levels and treating the [[inflammation]]. Treatment regimen involves [[Lugol's iodine]], [[Antithyroid agents|antithyroid drugs]] and [[Beta blockers|β-adrenergic blockers]]. In some cases, [[radioactive iodine]] may be used to treat an overactive [[thyroid gland]].


==Medical Therapy==
==Medical Therapy==
*Pharmacologic medical therapy is recommended among patients with goiter.<ref name="Astwood1960">{{cite journal|last1=Astwood|first1=E. B.|title=Treatment of Goiter and Thyroid Nodules with Thyroid|journal=JAMA|volume=174|issue=5|year=1960|pages=459|issn=0098-7484|doi=10.1001/jama.1960.03030050001001}}</ref><ref name="pmid2709545">{{cite journal |vauthors=Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P |title=The aging thyroid. The use of thyroid hormone in older persons |journal=JAMA |volume=261 |issue=18 |pages=2653–5 |year=1989 |pmid=2709545 |doi= |url=}}</ref><ref name="Sawin1989">{{cite journal|last1=Sawin|first1=Clark T.|title=The Aging Thyroid|journal=JAMA|volume=261|issue=18|year=1989|pages=2653|issn=0098-7484|doi=10.1001/jama.1989.03420180077034}}</ref><ref name="pmid23008749">{{cite journal |vauthors=Führer D, Bockisch A, Schmid KW |title=Euthyroid goiter with and without nodules--diagnosis and treatment |journal=Dtsch Arztebl Int |volume=109 |issue=29-30 |pages=506–15; quiz 516 |year=2012 |pmid=23008749 |pmc=3441105 |doi=10.3238/arztebl.2012.0506 |url=}}</ref><ref name="BaskinCobin2002">{{cite journal|last1=Baskin|first1=H. Jack|last2=Cobin|first2=Rhoda H.|last3=Duick|first3=Daniel S.|last4=Gharib|first4=Hossein|last5=Guttler|first5=Richard B.|last6=Kaplan|first6=Michael M.|last7=Segal|first7=Robert L.|last8=Garber|first8=Jeffrey R.|last9=Hamilton|first9=Carlos R.|last10=Handelsman|first10=Yehuda|last11=Hellman|first11=Richard|last12=Kukora|first12=John S.|last13=Levy|first13=Philip|last14=Palumbo|first14=Pasquale J.|last15=Petak|first15=Steven M.|last16=Rettinger|first16=Herbert I.|last17=Rodbard|first17=Helena W.|last18=Service|first18=F. John|last19=Shankar|first19=Talla P.|last20=Stoffer|first20=Sheldon S.|last21=Tourtelot|first21=John B.|title=AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM|journal=Endocrine Practice|volume=8|issue=6|year=2002|pages=457–469|issn=1530-891X|doi=10.4158/1934-2403-8.6.457}}</ref><ref name="WescheTiel-v Buul2001">{{cite journal|last1=Wesche|first1=Maria F. T.|last2=Tiel-v Buul|first2=Monique M. C.|last3=Lips|first3=Paul|last4=Smits|first4=Nico J.|last5=Wiersinga|first5=Wilmar M.|title=A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=86|issue=3|year=2001|pages=998–1005|issn=0021-972X|doi=10.1210/jcem.86.3.7244}}</ref><ref name="BonnemaBertelsen1999">{{cite journal|last1=Bonnema|first1=Steen J.|last2=Bertelsen|first2=Henrik|last3=Mortensen|first3=Jesper|last4=Andersen|first4=Peter B.|last5=Knudsen|first5=Dorthe U.|last6=Bastholt|first6=Lars|last7=Hegedüs|first7=Laszlo|title=The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=84|issue=10|year=1999|pages=3636–3641|issn=0021-972X|doi=10.1210/jcem.84.10.6052}}</ref><ref name="NygaardKnudsen1997">{{cite journal|last1=Nygaard|first1=Birte|last2=Knudsen|first2=Jens Helmer|last3=Hegedüs|first3=Laszlo|last4=Scient|first4=Annegrete Veje Cand|last5=Mølholm Hansen|first5=Jens Erik|title=Thyrotropin Receptor Antibodies and Graves’ Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=82|issue=9|year=1997|pages=2926–2930|issn=0021-972X|doi=10.1210/jcem.82.9.4227}}</ref><ref name="GreerAstwood1953">{{cite journal|last1=Greer|first1=Monte A.|last2=Astwood|first2=E. B.|title=TREATMENT OF SIMPLE GOITER WITH THYROID*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=13|issue=11|year=1953|pages=1312–1331|issn=0021-972X|doi=10.1210/jcem-13-11-1312}}</ref><ref name="SquatritoVigneri1986">{{cite journal|last1=Squatrito|first1=S.|last2=Vigneri|first2=R.|last3=Rybello|first3=F.|last4=Ermans|first4=A. M.|last5=Polley|first5=R. D.|last6=Ingbar|first6=S. H.|title=Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=63|issue=2|year=1986|pages=368–375|issn=0021-972X|doi=10.1210/jcem-63-2-368}}</ref><ref name="HegedüsBonnema2010">{{cite journal|last1=Hegedüs|first1=Laszlo|last2=Bonnema|first2=Steen J.|title=Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=95|issue=12|year=2010|pages=5155–5162|issn=0021-972X|doi=10.1210/jc.2010-1638}}</ref><ref name="HainesKeating1948">{{cite journal|last1=Haines|first1=Samuel F.|last2=Keating|first2=F. Raymond|last3=Power|first3=Marschelle H.|last4=Williams|first4=Marvin M. D.|last5=Kelsey|first5=Mavis P.|title=THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=813–825|issn=0021-972X|doi=10.1210/jcem-8-10-813}}</ref><ref name="Reveno1948">{{cite journal|last1=Reveno|first1=William S.|title=PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=866–874|issn=0021-972X|doi=10.1210/jcem-8-10-866}}</ref><ref name="BrentaSchnitman2003">{{cite journal|last1=Brenta|first1=G.|last2=Schnitman|first2=M.|last3=Fretes|first3=O.|last4=Facco|first4=E.|last5=Gurfinkel|first5=M.|last6=Damilano|first6=S.|last7=Pacenza|first7=N.|last8=Blanco|first8=A.|last9=Gonzalez|first9=E.|last10=Pisarev|first10=M. A.|title=Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid|journal=The Journal of Clinical Endocrinology & Metabolism|volume=88|issue=11|year=2003|pages=5287–5292|issn=0021-972X|doi=10.1210/jc.2003-030095}}</ref>  
*[[Pharmacological|Pharmacologic]] medical [[therapy]] is recommended among [[patients]] with goiter.<ref name="Astwood1960">{{cite journal|last1=Astwood|first1=E. B.|title=Treatment of Goiter and Thyroid Nodules with Thyroid|journal=JAMA|volume=174|issue=5|year=1960|pages=459|issn=0098-7484|doi=10.1001/jama.1960.03030050001001}}</ref><ref name="pmid2709545">{{cite journal |vauthors=Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P |title=The aging thyroid. The use of thyroid hormone in older persons |journal=JAMA |volume=261 |issue=18 |pages=2653–5 |year=1989 |pmid=2709545 |doi= |url=}}</ref><ref name="Sawin1989">{{cite journal|last1=Sawin|first1=Clark T.|title=The Aging Thyroid|journal=JAMA|volume=261|issue=18|year=1989|pages=2653|issn=0098-7484|doi=10.1001/jama.1989.03420180077034}}</ref><ref name="pmid23008749">{{cite journal |vauthors=Führer D, Bockisch A, Schmid KW |title=Euthyroid goiter with and without nodules--diagnosis and treatment |journal=Dtsch Arztebl Int |volume=109 |issue=29-30 |pages=506–15; quiz 516 |year=2012 |pmid=23008749 |pmc=3441105 |doi=10.3238/arztebl.2012.0506 |url=}}</ref><ref name="BaskinCobin2002">{{cite journal|last1=Baskin|first1=H. Jack|last2=Cobin|first2=Rhoda H.|last3=Duick|first3=Daniel S.|last4=Gharib|first4=Hossein|last5=Guttler|first5=Richard B.|last6=Kaplan|first6=Michael M.|last7=Segal|first7=Robert L.|last8=Garber|first8=Jeffrey R.|last9=Hamilton|first9=Carlos R.|last10=Handelsman|first10=Yehuda|last11=Hellman|first11=Richard|last12=Kukora|first12=John S.|last13=Levy|first13=Philip|last14=Palumbo|first14=Pasquale J.|last15=Petak|first15=Steven M.|last16=Rettinger|first16=Herbert I.|last17=Rodbard|first17=Helena W.|last18=Service|first18=F. John|last19=Shankar|first19=Talla P.|last20=Stoffer|first20=Sheldon S.|last21=Tourtelot|first21=John B.|title=AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM|journal=Endocrine Practice|volume=8|issue=6|year=2002|pages=457–469|issn=1530-891X|doi=10.4158/1934-2403-8.6.457}}</ref><ref name="WescheTiel-v Buul2001">{{cite journal|last1=Wesche|first1=Maria F. T.|last2=Tiel-v Buul|first2=Monique M. C.|last3=Lips|first3=Paul|last4=Smits|first4=Nico J.|last5=Wiersinga|first5=Wilmar M.|title=A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=86|issue=3|year=2001|pages=998–1005|issn=0021-972X|doi=10.1210/jcem.86.3.7244}}</ref><ref name="BonnemaBertelsen1999">{{cite journal|last1=Bonnema|first1=Steen J.|last2=Bertelsen|first2=Henrik|last3=Mortensen|first3=Jesper|last4=Andersen|first4=Peter B.|last5=Knudsen|first5=Dorthe U.|last6=Bastholt|first6=Lars|last7=Hegedüs|first7=Laszlo|title=The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=84|issue=10|year=1999|pages=3636–3641|issn=0021-972X|doi=10.1210/jcem.84.10.6052}}</ref><ref name="NygaardKnudsen1997">{{cite journal|last1=Nygaard|first1=Birte|last2=Knudsen|first2=Jens Helmer|last3=Hegedüs|first3=Laszlo|last4=Scient|first4=Annegrete Veje Cand|last5=Mølholm Hansen|first5=Jens Erik|title=Thyrotropin Receptor Antibodies and Graves’ Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1|journal=The Journal of Clinical Endocrinology & Metabolism|volume=82|issue=9|year=1997|pages=2926–2930|issn=0021-972X|doi=10.1210/jcem.82.9.4227}}</ref><ref name="GreerAstwood1953">{{cite journal|last1=Greer|first1=Monte A.|last2=Astwood|first2=E. B.|title=TREATMENT OF SIMPLE GOITER WITH THYROID*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=13|issue=11|year=1953|pages=1312–1331|issn=0021-972X|doi=10.1210/jcem-13-11-1312}}</ref><ref name="SquatritoVigneri1986">{{cite journal|last1=Squatrito|first1=S.|last2=Vigneri|first2=R.|last3=Rybello|first3=F.|last4=Ermans|first4=A. M.|last5=Polley|first5=R. D.|last6=Ingbar|first6=S. H.|title=Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=63|issue=2|year=1986|pages=368–375|issn=0021-972X|doi=10.1210/jcem-63-2-368}}</ref><ref name="HegedüsBonnema2010">{{cite journal|last1=Hegedüs|first1=Laszlo|last2=Bonnema|first2=Steen J.|title=Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter|journal=The Journal of Clinical Endocrinology & Metabolism|volume=95|issue=12|year=2010|pages=5155–5162|issn=0021-972X|doi=10.1210/jc.2010-1638}}</ref><ref name="HainesKeating1948">{{cite journal|last1=Haines|first1=Samuel F.|last2=Keating|first2=F. Raymond|last3=Power|first3=Marschelle H.|last4=Williams|first4=Marvin M. D.|last5=Kelsey|first5=Mavis P.|title=THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=813–825|issn=0021-972X|doi=10.1210/jcem-8-10-813}}</ref><ref name="Reveno1948">{{cite journal|last1=Reveno|first1=William S.|title=PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER|journal=The Journal of Clinical Endocrinology & Metabolism|volume=8|issue=10|year=1948|pages=866–874|issn=0021-972X|doi=10.1210/jcem-8-10-866}}</ref><ref name="BrentaSchnitman2003">{{cite journal|last1=Brenta|first1=G.|last2=Schnitman|first2=M.|last3=Fretes|first3=O.|last4=Facco|first4=E.|last5=Gurfinkel|first5=M.|last6=Damilano|first6=S.|last7=Pacenza|first7=N.|last8=Blanco|first8=A.|last9=Gonzalez|first9=E.|last10=Pisarev|first10=M. A.|title=Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid|journal=The Journal of Clinical Endocrinology & Metabolism|volume=88|issue=11|year=2003|pages=5287–5292|issn=0021-972X|doi=10.1210/jc.2003-030095}}</ref>  


*In cases of [[hypothyroidism]], thyroid hormone replacement with [[levothyroxine]] may help resolve [[hypothyroidism]] symptoms and also help with the slow release of [[TSH]] ([[Thyroid Stimulating Hormone]]) from [[pituitary]] which would result in the decrease in the size of the goiter.
*In cases of [[hypothyroidism]], [[thyroid hormone]] replacement with [[levothyroxine]] may help resolve [[hypothyroidism]] symptoms and also help with the slow release of [[TSH]] ([[Thyroid Stimulating Hormone]]) from [[pituitary]] which would result in the decrease in the size of the goiter.
*In [[hyperthyroidism]], treatment targeted at normalizing hormone levels is considered.
*In [[hyperthyroidism]], treatment targeted at normalizing [[thyroid hormone]] levels is considered.
*In cases of [[inflammation]] of thyroid gland, medication to treat the [[inflammation]] are generally prescribed. For goiters associated with [[hyperthyroidism]], you may need medications to normalize [[hormone]] levels.
*In cases of [[inflammation]] of [[thyroid gland]], medication to treat the [[inflammation]] are generally prescribed. For goiters associated with [[hyperthyroidism]], you may need [[medications]] to normalize [[thyroid hormone]] levels.
*'''[[Radioactive Iodine]]:''' In some cases, [[radioactive iodine]] may be used to treat an overactive thyroid gland. [[Radioactive iodine]] is prescribed as an oral medication which helps destroy thyroid cells resulting in the decreasing the size of the goiter. This therapy may also lead to under-activity of the [[thyroid gland]].
*'''[[Radioactive Iodine]]:''' In some cases, [[radioactive iodine]] may be used to treat an overactive [[thyroid gland]]. [[Radioactive iodine]] is prescribed as an [[oral]] medication which helps destroy thyroid cells resulting in the decreasing the size of the goiter. This therapy may also lead to under-activity of the [[thyroid gland]].
*[[Lugol's iodine]]:
*[[Lugol's iodine]]:
**Decreases thyroid hormone synthesis  
**Decreases [[thyroid hormone]] synthesis  
**Decreases [[vascularity]]  
**Decreases [[vascularity]]  
*[[Antithyroid drugs]] such as [[carbimazole]]:
*[[Antithyroid drugs]] such as [[carbimazole]]:

Revision as of 17:50, 13 October 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Pharmacologic medical therapy for goiter involves normalizing thyroid hormone levels and treating the inflammation. Treatment regimen involves Lugol's iodine, antithyroid drugs and β-adrenergic blockers. In some cases, radioactive iodine may be used to treat an overactive thyroid gland.

Medical Therapy

References

  1. ↑ Astwood, E. B. (1960). "Treatment of Goiter and Thyroid Nodules with Thyroid". JAMA. 174 (5): 459. doi:10.1001/jama.1960.03030050001001. ISSN 0098-7484.
  2. ↑ Sawin CT, Geller A, Hershman JM, Castelli W, Bacharach P (1989). "The aging thyroid. The use of thyroid hormone in older persons". JAMA. 261 (18): 2653–5. PMID 2709545.
  3. ↑ Sawin, Clark T. (1989). "The Aging Thyroid". JAMA. 261 (18): 2653. doi:10.1001/jama.1989.03420180077034. ISSN 0098-7484.
  4. ↑ Führer D, Bockisch A, Schmid KW (2012). "Euthyroid goiter with and without nodules--diagnosis and treatment". Dtsch Arztebl Int. 109 (29–30): 506–15, quiz 516. doi:10.3238/arztebl.2012.0506. PMC 3441105. PMID 23008749.
  5. ↑ Baskin, H. Jack; Cobin, Rhoda H.; Duick, Daniel S.; Gharib, Hossein; Guttler, Richard B.; Kaplan, Michael M.; Segal, Robert L.; Garber, Jeffrey R.; Hamilton, Carlos R.; Handelsman, Yehuda; Hellman, Richard; Kukora, John S.; Levy, Philip; Palumbo, Pasquale J.; Petak, Steven M.; Rettinger, Herbert I.; Rodbard, Helena W.; Service, F. John; Shankar, Talla P.; Stoffer, Sheldon S.; Tourtelot, John B. (2002). "AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM". Endocrine Practice. 8 (6): 457–469. doi:10.4158/1934-2403-8.6.457. ISSN 1530-891X.
  6. ↑ Wesche, Maria F. T.; Tiel-v Buul, Monique M. C.; Lips, Paul; Smits, Nico J.; Wiersinga, Wilmar M. (2001). "A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter". The Journal of Clinical Endocrinology & Metabolism. 86 (3): 998–1005. doi:10.1210/jcem.86.3.7244. ISSN 0021-972X.
  7. ↑ Bonnema, Steen J.; Bertelsen, Henrik; Mortensen, Jesper; Andersen, Peter B.; Knudsen, Dorthe U.; Bastholt, Lars; Hegedüs, Laszlo (1999). "The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function1". The Journal of Clinical Endocrinology & Metabolism. 84 (10): 3636–3641. doi:10.1210/jcem.84.10.6052. ISSN 0021-972X.
  8. ↑ Nygaard, Birte; Knudsen, Jens Helmer; Hegedüs, Laszlo; Scient, Annegrete Veje Cand; Mølholm Hansen, Jens Erik (1997). "Thyrotropin Receptor Antibodies and Graves' Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1". The Journal of Clinical Endocrinology & Metabolism. 82 (9): 2926–2930. doi:10.1210/jcem.82.9.4227. ISSN 0021-972X.
  9. ↑ Greer, Monte A.; Astwood, E. B. (1953). "TREATMENT OF SIMPLE GOITER WITH THYROID*". The Journal of Clinical Endocrinology & Metabolism. 13 (11): 1312–1331. doi:10.1210/jcem-13-11-1312. ISSN 0021-972X.
  10. ↑ Squatrito, S.; Vigneri, R.; Rybello, F.; Ermans, A. M.; Polley, R. D.; Ingbar, S. H. (1986). "Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*". The Journal of Clinical Endocrinology & Metabolism. 63 (2): 368–375. doi:10.1210/jcem-63-2-368. ISSN 0021-972X.
  11. ↑ Hegedüs, Laszlo; Bonnema, Steen J. (2010). "Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter". The Journal of Clinical Endocrinology & Metabolism. 95 (12): 5155–5162. doi:10.1210/jc.2010-1638. ISSN 0021-972X.
  12. ↑ Haines, Samuel F.; Keating, F. Raymond; Power, Marschelle H.; Williams, Marvin M. D.; Kelsey, Mavis P. (1948). "THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*". The Journal of Clinical Endocrinology & Metabolism. 8 (10): 813–825. doi:10.1210/jcem-8-10-813. ISSN 0021-972X.
  13. ↑ Reveno, William S. (1948). "PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER". The Journal of Clinical Endocrinology & Metabolism. 8 (10): 866–874. doi:10.1210/jcem-8-10-866. ISSN 0021-972X.
  14. ↑ Brenta, G.; Schnitman, M.; Fretes, O.; Facco, E.; Gurfinkel, M.; Damilano, S.; Pacenza, N.; Blanco, A.; Gonzalez, E.; Pisarev, M. A. (2003). "Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid". The Journal of Clinical Endocrinology & Metabolism. 88 (11): 5287–5292. doi:10.1210/jc.2003-030095. ISSN 0021-972X.

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