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The Rational Clinical Examination
David L. Simel, Drummond Rennie
David L. Simel, Adi Cohen
Make the Diagnosis: Goiter

Topics Discussed: criterion standard comparisons (diagnostic tests), goiter, likelihood ratio, make the diagnosis, prior probability, thyroid, thyroid diseases

Excerpt: "The prior probability of a goiter is affected by many variables, including the patient's body surface area, sex, and regional variations associated with the endemic iodine deficiency. Two recent European studies of thyroid volume among community samples of healthy adults give us insight into the prevalence of goiter in the non–iodine-deficient area: 4% of patients in Spain (95% confidence interval [CI], 3%-6%)8 and 10% of patients in France (95% CI, 9%-11%)9 had palpable goiters. Unfortunately, the thyroid volume was not confirmed for patients with palpable goiters. Nonetheless, we can make some inferences that give us good starting points. The WHO defines an iodine-deficient area by the prevalence of goiter in school-aged children. According to normative population values, children who live in a non–iodine-deficient area should have a goiter prevalence of less than 5%.1 Adults might have palpable thyroid glands for reasons other than iodine deficiency, so prevalence values slightly higher make sense. A starting point of 5% to 10% for healthy adults makes sense for the prior probability of a palpable thyroid...."
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