The Rational Clinical Examination
David L. Simel, Drummond Rennie
Goiter
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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