The natural clinical course of children with an initial diagnosis of simple goiter: A 5-year longitudinal follow-up

A total of 154 children initially diagnosed as simple goiter were evaluated annually for 5 years, The mean age at diagnosis was 12.8 +/- 1.8 years, The annual evaluation consisted of clinical assessment for height, weight, pubertal status, goiter size, and laboratory measurements for free thyroxine (FT4), thyrotropin (TSH), anti-thyroglobulin and anti-microsomal antibodies. At initial diagnosis, goiter was grade I in 117 children (76%) and grade II in 37 children (24%). All children had normal FT4, TSH and negative thyroid antibodies, After 5 years of follow-up, there were 6 children who later had positive thyroid antibodies in the 3(rd) and 4(th) year and the diagnosis was changed to chronic lymphocytic thyroiditis, In one patient TSH level was elevated in the third year and later increased which is strongly suggestive of compensated hypothyroidism. All children had normal growth as shown by the average final adult height of 2.67 +/- 1.25 cm above the mid-parental height. In girls the average age at menarche was 12.5 +/- 1.4 years which was not different from normal children. The goiter decreased in size in 36 children (23.4%) and remained the same size in 113 children (73.4%) without any medication, We concluded that 1) children who were initially diagnosed as simple goiter need to be followed annually for at least 5 years, and 2) the minimal annual laboratory evaluation should be TSH and thyroid antibodies to detect the early stage of chronic lymphocytic thyroiditis and compensated hypothyroidism.