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The thyroid gland produces hormones that regulate various functions in the body. When the diseased thyroid gland enlarges, it is called goiter.
A goiter with multiple nodules is termed multinodular goiter. The reasons for its development are not known. Multinodular goiter is most often asymptomatic. However, they are associated with a higher risk of cancer. Its treatment depends on:
Toxic multinodular goiter, or TMNG, contains at least two autonomously functioning nodules that produce excessive thyroid hormones. In the elderly, multinodular goiter is the most common cause of hyperthyroidism. This type of goiter develops slowly and is diagnosed only on routine blood tests. It may evolve to cause a critical condition, thyrotoxicosis.
In Graves' disease, near-total thyroidectomy (NTT) is the treatment of choice, but the optimal therapy for TMNG is debatable.
Typically, there are two treatment options for TMNG:
Anti-thyroid drugs are rarely successful in the long term. If surgery is not an option, percutaneous ultrasound-guided ethanol injection in the toxic nodules can be helpful. Thyroidectomy may be a beneficial choice of treatment for the disorder. However, patients will be subjected to the risk of surgery and the possible complications of recurrent nerve injury and hypocalcemia.
Most multinodular goiters are asymptomatic and are diagnosed during a regular physical examination. Some symptoms of multinodular goiter are:
A large multinodular goiter can also present clinical symptoms, especially when it expands to the chest. Such a condition presents the following symptoms:
Multinodular goiter is a result of the following conditions:
Doctors enquire about the patient's health conditions, ongoing medications, and personal or familial history of goiter or thyroid-related disorders. A physical examination may reveal one or many nodules in the thyroid. In addition, the thyroid appears enlarged, and there may be a rapid heart rate or a tremor.
Other tests may include:
The treatment of toxic multinodular goiter depends on its size, signs and symptoms, and underlying cause. If the goiter is small and thyroid function is healthy, the doctor would recommend a monitoring approach with timely check-ups.
Medications for TMNG may include the following:
The thyroid gland may need to be removed surgically. Sometimes, only a part of the thyroid is removed (partial thyroidectomy). Goiter presenting with the following complications requires surgical intervention:
Depending on the amount of thyroid removed, thyroid hormone replacement therapy may be needed to achieve better results.
iodine, taken orally, suppresses an overactive thyroid gland. The thyroid gland absorbs the radioactive iodine and destroys thyroid cells. The treatment eliminates or reduces hormone production. Additionally, it may decrease the size of the goiter.
Complications of multinodular goiter are associated with the organs their produced hormones affect. These include:
Some factors that contribute to the development of multinodular goiter are:
Most multinodular goiters are asymptomatic. However, if the symptoms of hyperthyroidism are evident, or there is difficulty in breathing or swallowing, contact the doctor or medical facility immediately.
Multinodular goiters increase the risk of developing thyroid cancer. However, they can be cured with medication, radioactive iodine therapy, or surgery. Multinodular goiters, in general, are not life-threatening.
Reviewed by Dr. Jimmy Pathak, Consultant - Endocrinology & Diabetes, Diabesity Clinic.
Max Healthcare is home to 5000 eminent doctors in the world, most of whom are pioneers in their respective fields. Additionally, they are renowned for developing innovative and revolutionary clinical procedures.
Max Healthcare is home to 5000 eminent doctors in the world, most of whom are pioneers in their respective fields. Additionally, they are renowned for developing innovative and revolutionary clinical procedures.
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