Management of Non-Toxic Multinodular Goitre

Abstract

Multinodular goitre (MNG) is a common thyroid disorder associated with more than one thyroid nodule. The clinical presentation varies from a completely asymptomatic goitre to a life-threatening disease with upper airway compression. Patients should have a careful clinical evaluation, thyroid function tests, ultrasonography, cross-sectional imaging, and fine-needle aspiration. The best therapeutic approach will depend on the size and location of the goitre, the presence of compressive symptoms and the clinical status. The recommended treatments include clinical observation, surgery, and administration of radioactive iodine (131I). Suppressive treatment with levothyroxine is discouraged due to its low efficacy compared with surgery or 131I and adverse effects. Total thyroidectomy is effective, but surgical complications may occur. The use of radioiodine after the elevation of thyroid-stimulating hormone (TSH) levels, either via the exogenous administration of recombinant human TSH or through the induction of transient primary subclinical hypothyroidism by antithyroid drugs, are relative novel alternative treatments.