[Toxic multinodular goiter]

We report a series of 70 patients with toxic multinodular goiter (TMNG) and analyze results after surgical removal.

Over a 15-year period, patients underwent thyroid surgery for TMNG. The large majority, 85.5% were women and mean age was 40 years. All patients had had goiter for more than 5 years. Clinical signs of toxicity were present in all patients, 100% presented tachycardia and palpitations. Nodules were identified at ultrasound in 95% of the patients and at scintigraphy in 90%. Serum T4 was elevated in 40 patients and THS was depressed in all. The chest x-ray revealed a plunging goiter in 10 patients. All patients were given medical treatment prior to surgery for total thyroidectomy in 15 and subtotal thyroidectomy in 55. There were no deaths. Two patients developed hematomas, to suffered injury to the recurrent nerve, and five developed acute hypoparathyroidism. Three cases of thyroid carcinoma were observed.

TMNG is an indication for radical treatment, generally surgery. Medical treatment is required in preparation for surgery. Total thyroidectomy is used increasingly, providing a definitive cure of toxic hyperthyroidism and avoiding the risk of recurrence. With increasing surgical skill, the risk of recurrent or parathyroid injury is greatly decreased.