[Large goiter--diagnosis and treatment]

Area of Science:

• Endocrinology and Thyroidology
• Surgical Oncology
• Diagnostic Imaging

Background:

• Large goiters are infrequent in Norway, unlike iodine-deficient regions.
• Benign multinodular goiter is the primary cause, with thyroid cancer and autoimmune thyroid disease as key differentials.
• Most multinodular goiters exhibit slow growth and minimal discomfort, even when large.

Observation:

• Diagnostic work-up focuses on identifying goiter etiology and complications such as hyperthyroidism, compressive symptoms, or cosmetic concerns.
• Ultrasound-guided fine needle aspiration cytology is the paramount diagnostic modality when malignancy is suspected.
• While imaging lacks definitive benign/malignant differentiation, ultrasound aids cytological sampling.

Findings:

• Treatment decisions for multinodular goiter complications are guided by patient's overall health, surgical risks, and personal preferences.
• Not all patients necessitate treatment; management options include thyroidectomy, partial resection, and radioiodine therapy.
• Pre-treatment with recombinant human thyroid stimulating hormone can enhance radioiodine efficacy, potentially broadening non-surgical treatment indications.

Implications:

• Establishes a structured approach to diagnosing and managing large goiters, emphasizing individualized treatment strategies.
• Highlights the critical role of fine needle aspiration cytology and ultrasound in differentiating benign from malignant thyroid lesions.
• Suggests potential for expanded non-surgical treatment options through optimized radioiodine therapy protocols.