[Multinodular goiter: natural history]

Despite its high prevalence, at least in areas with even mild iodine deficiency, the aetiopathogenesis of multinodular goitre is poorly understood. The combination of genetic and environmental factors, the likely involvement of endocrine para and autocrine goitrogenic agents and the remarkable heterogenicity of thyroid tissue complicate elucidation of the mechanisms involved. Multinodular goitre follows an initial phase of hyperplastic goitre or results from the generation of several individual nodules. Alterations of the stromal and vascular tissues as well as the occurrence of somatic mutations are contributing factors. In many instances, multinodular goitres become autonomous in the long term.