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Evaluation and management of multinodular goiter
1Mayo Medical School, Rochester, Minnesota, USA.
Otolaryngologic Clinics of North America
|August 1, 1996
Summary
Nodular goiters are common, affecting women more than men. Management depends on symptoms and fine-needle aspiration (FNA) results, with surgery often preferred for large or symptomatic goiters.
Area of Science:
- Endocrinology
- Thyroidology
Background:
- Nodular goiters are prevalent, with an incidence of 0.1%–1.5% annually in the US.
- They are more common in women, the elderly, and those with a history of irradiation.
- Goiters can be asymptomatic (nontoxic) or cause thyrotoxic symptoms (toxic multinodular goiter).
Purpose of the Study:
- To outline diagnostic and management strategies for nodular goiters.
- To provide recommendations for treating both toxic and nontoxic multinodular goiters.
Main Methods:
- Clinical evaluation, biochemical testing (serum TSH), fine-needle aspiration (FNA), and imaging studies (ultrasonography, CT).
- Assessment of thyroid function, nodule characteristics, and compression symptoms.
Main Results:
- Serum TSH is a reliable indicator of thyroid function.
- FNA is crucial for assessing cancer risk.
- Treatment indications include hyperthyroidism, compression, cosmesis, and malignancy concerns.
Conclusions:
- Asymptomatic, nontoxic goiters with benign FNA results require yearly monitoring.
- Levothyroxine suppression therapy for nontoxic goiters is controversial and often ineffective.
- Surgery is preferred for large nontoxic goiters with compression symptoms; surgery or radioiodine are options for toxic MNG.