Condition Overview
Multinodular goiter (MNG) is a condition characterized by an enlarged thyroid gland containing multiple distinct nodules. These nodules can vary in size and may be solid or cystic. MNG is a common thyroid disorder, especially in regions with iodine deficiency, but it can also occur in iodine-sufficient areas. The exact cause of MNG is not always clear, but factors such as genetics, age, and prolonged stimulation of the thyroid gland by thyroid-stimulating hormone (TSH) may contribute to its development.
Patients with MNG may be asymptomatic or present with symptoms related to the size of the goiter and its impact on surrounding structures. Symptoms can include a visible swelling in the neck, difficulty swallowing (dysphagia), difficulty breathing (dyspnea), hoarseness, and a sensation of pressure in the neck. In some cases, MNG can lead to hyperthyroidism (toxic multinodular goiter) or hypothyroidism, depending on the functional status of the nodules.
Diagnosis involves a thorough clinical evaluation, ultrasound imaging to assess the size and characteristics of the nodules, and thyroid function tests to determine the hormonal activity of the gland. Fine-needle aspiration biopsy (FNAB) may be performed on suspicious nodules to rule out malignancy.
Treatment Options
- Active Surveillance
- Description: Active surveillance involves regular monitoring of the MNG with periodic ultrasound examinations and clinical evaluations. This approach is suitable for patients with asymptomatic, non-toxic MNG who have no signs of malignancy.
- Indications: Asymptomatic MNG, patient preference to avoid surgery, low-risk nodules, no evidence of malignancy or significant growth.
- Radiofrequency Ablation (RFA)
- Description: RFA is a minimally invasive procedure that uses heat generated by radiofrequency energy to destroy nodule tissue. It can reduce the size of nodules and alleviate compressive symptoms without the need for surgery. This is usually best for patients with only a few enlarged nodules. If there are too many, it can be challenging to follow them over time, and surgery may be a better option.
- Indications: Symptomatic nodules, patients seeking non-surgical treatment, nodules causing compressive symptoms, benign nodules.
- Thyroid Lobectomy
- Description: This surgical procedure involves the removal of one lobe of the thyroid gland. It is often recommended for patients with large, symptomatic nodules or nodules with indeterminate biopsy results. Because we prefer to preserve as much thyroid tissue as is safely possible, we will often recommend a lobectomy when there is a dominant nodule and the other nodules are smaller or less symptomatic.
- Indications: Large or symptomatic nodules, indeterminate or suspicious FNAB results, patient preference for conservative surgery.
- Total Thyroidectomy
- Description: Total thyroidectomy involves the complete removal of the thyroid gland. It is considered for patients with large MNG causing significant symptoms, those with cosmetic concerns, or in cases where there is a high suspicion of malignancy.
- Indications: Large or symptomatic MNG, high-risk nodules, significant cosmetic concerns, confirmed or suspected malignancy.
- Radioactive Iodine (RAI) Therapy
- Description: RAI therapy involves the oral administration of radioactive iodine to reduce the size of the thyroid gland and its nodules. This treatment is particularly useful for toxic multinodular goiter causing hyperthyroidism. This treatment is rarely recommended if thyroid function is normal, but can be effective for toxic MNG (if thyroid function is abnormally elevated).
- Indications: Toxic MNG, patients unsuitable for surgery, those preferring non-surgical treatment, recurrent or persistent hyperthyroidism.
Management of MNG requires a multidisciplinary approach involving endocrinologists, radiologists, and surgeons. The choice of treatment depends on the size and characteristics of the goiter, the presence of symptoms, patient preferences, and overall risk assessment. Regular monitoring and follow-up are essential to detect any changes in the nodules' size or characteristics and to adjust the management plan as needed. Having an experienced team such as that at the Russell Center ensures that you will have access to the widest range of options for your moltinodular goiter.
