Prognosis and duration of disabling effects

Goitre

If untreated euthyroid goitre usually progresses slowly but adverse effects are limited to the increasing cosmetic defect of the swelling and the possibility of secondary pressure effects. Once treated the size of the gland should gradually regress over a period of several months. No residual disability and no variability in the condition would be expected.

Myxoedema

Onset of symptoms of myxoedema is usually insidious and the condition may not be recognised in early stages. Once the condition has been diagnosed and treated recovery should be complete with no residual disability after a few month’s treatment. Relapse can occur as a result of poor compliance with treatment but day-to-day variability in the condition would not be expected.

Thyrotoxicosis

Thyrotoxicosis tends to develop insidiously at first but progresses fairly rapidly to overt symptoms. Treatment should achieve control of the condition in the great majority of cases with many achieving an effective cure. Long-term follow-up to monitor progress may be needed.

Symptomatic improvement should occur within three months of treatment and unless there is medical evidence of complications that are not amenable to treatment, no continuing loss of function would be expected. Function of limbs or spine, the cardiovascular system and mental state would be expected to be normal.

Once recognised and treated there should be little or no variability other than from adverse effects of antithyroid drugs or poor compliance with treatment. Such changes should be recognisable by the patient and effectively managed by routine medical follow-up.

Apart from when caused by malignant disease or where secondary to another coincidental condition, thyrotoxicosis can be treated effectively. Life-long medication may be needed in some cases but patients should be able to follow a normal life-style with no continuing disability. There would need to be medical evidence of chronic secondary complications or difficulty with control of the condition, to support claims of chronic functional disability from this and other thyroid disorders.