Benign thyroid enlargement (non-toxic multinodular goiter): Treatment
The natural history of benign goiterGoiter - enlarged thyroid is usually slow growth of the nodules. Therefore, observation can be safe. MNGMNG - Multinodular goiter; enlarged thyroid that contains multiple nodules is treated if there is a suspicion of the nodules harboring cancer, the goiter is growing quickly, or if the goiter's large size is causing compressive symptoms, such as hoarseness, difficulty swallowing, or difficulty breathing. Use of thyroid hormone to attempt to "suppress" and shrink MNG is not indicated and puts patients at risk for hyperthyroidismHyperthyroidism - overactive thyroid.
Surgery for MNG, as stated above, is indicated when FNAFNA - fine needle aspiration biopsy of a dominant nodule is suspicious for malignancy, the goiter is growing rapidly, or there are compressive symptoms due to the size of the goiter. The extent of surgery is based on the suspicion for malignancy, presence of thyroid dysfunction, and presence of bilateral nodules. In patients who have normal thyroid function, with compressive symptoms due to a single nodule, with a benign biopsy, and no nodules on the opposite side, unilateral thyroid lobectomyLobectomy - removal of half the thyroid is appropriate. Otherwise total thyroidectomyTotal thyroidectomy - removal of the whole thyroid is the operation of choice. (See Thyroid Surgery)
RAI ablationRAI ablation - the use of radioactive iodine to destroy thyroid cells (either benign or cancer) may be an option in the treatment of MNG. It is usually reserved for patients who are not able to have an operation because of other medical problems which would make surgery too risky.