Approach to the patient with nontoxic multinodular goiter

Rebecca S. Bahn, M. Regina Castro

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

Thyroid nodules are very common, and although the majority are benign, approximately 5% may harbor malignancy. The evaluation of the patient with solitary thyroid nodule is generally straightforward and will typically include measurement of serum TSH to assess thyroid function and fine-needle aspiration biopsy of the nodule, with or without ultrasound (US) guidance. The approach to the patient with nontoxic multinodular goiter represents a more difficult problem for the clinician. All patients should have serum TSH measured to assess functional thyroid status and US examination to evaluate the number, size, and sonographic features of the nodules and assist in the selection of nodules that may need fine-needle aspiration biopsy. Patients with nodules yielding malignant cytology should be referred for surgery. Given the lack of reliable markers to predict biological behavior of nodules with suspicious (indeterminate) cytology, patients with such nodules are generally advised to have surgery, unless autonomous function of these nodules can be confirmed by scintigraphy. Most of these patients, however, will ultimately prove to have benign follicular tumors. Many patients with benign but large goiters may experience clinical symptoms of pressure, such as dysphagia, choking sensation, or airway obstruction. Such patients will often require surgery for alleviation of symptoms. In the absence of malignancy, asymptomatic patients may be observed. Radioactive iodine, commonly used in many parts of Europe, is safe and effective and may be a reasonable option for many patients. Periodic follow-up with neck palpation and US exam is recommended for all patients.

Original languageEnglish (US)
Pages (from-to)1202-1212
Number of pages11
JournalJournal of Clinical Endocrinology and Metabolism
Volume96
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Goiter
Cytology
Surgery
Biopsy
Ultrasonics
Needles
Ports and harbors
Iodine
Tumors
Thyroid Nodule
Airway Obstruction
Fine Needle Biopsy
Cell Biology
Thyroid Gland
Neoplasms
Palpation
Deglutition Disorders
Serum
Radionuclide Imaging
Neck

ASJC Scopus subject areas

  • Biochemistry
  • Clinical Biochemistry
  • Endocrinology
  • Biochemistry, medical
  • Endocrinology, Diabetes and Metabolism

Cite this

Approach to the patient with nontoxic multinodular goiter. / Bahn, Rebecca S.; Castro, M. Regina.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 96, No. 5, 05.2011, p. 1202-1212.

Research output: Contribution to journalArticle

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