Multinodular Goiter - PubMed (original) (raw)

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Kenneth R Feingold 1, Bradley Anawalt 2, Marc R Blackman 3, Alison Boyce 4, George Chrousos [ 5](#full-view-book-affiliation-5 "Professor of Pediatrics and Endocrinology, Division of Endocrinology, Metabolism and Diabetes, First Department of Pediatrics, National and Kapodistrian University of Athens Medical School, "Aghia Sophia" Children's Hospital, Athens, Greece"), Emiliano Corpas 6, Wouter W de Herder 7, Ketan Dhatariya 8, Kathleen Dungan 9, Johannes Hofland 10, Sanjay Kalra 11, Gregory Kaltsas 12, Nitin Kapoor 13, Christian Koch 14, Peter Kopp 15, Márta Korbonits 16, Christopher S Kovacs 17, Wendy Kuohung 18, Blandine Laferrère 19, Miles Levy 20, Elizabeth A McGee 21, Robert McLachlan 22, Maria New 23, Jonathan Purnell 24, Rakesh Sahay 25, Amy S Shah 26, Frederick Singer 27, Mark A Sperling 28, Constantine A Stratakis 29, Dace L Trence 30, Don P Wilson 31

, editors.

In: Endotext [Internet]. South Dartmouth (MA): MDText.com, Inc.; 2000.

2016 Sep 26.

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Multinodular Goiter

Geraldo Medeiros-Neto.

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Excerpt

Multinodular goiter (MNG) is the most common of all the disorders of the thyroid gland. MNG is the result of the genetic heterogeneity of follicular cells and apparent acquisition of new cellular qualities that become inheritable. Nodular goiter is most often detected simply as a mass in the neck, but sometimes an enlarging gland produces pressure symptoms. Hyperthyroidism develops in a large proportion of MNGs after a few decades, frequently after iodine excess. Diagnosis is based on the physical examination. Thyroid function test results are normal, or indicate subclinical or overt hyperthyroidism. Imaging procedures are useful to detect details such as distortion of the trachea, and to provide an estimation of the volume before and after therapy. From 4 to 17% of MNGs fulfill the criteria of malignant change, however, the majority of these lesions are not lethal. If a clinical and biochemically euthyroid MNG is small and produces no symptoms, treatment is controversial. T4 given to shrink the gland or to prevent further growth is effective in about one third of patients. If the clinically euthyroid goiter is unsightly, shows subclinical hyperthyroidism or is causing pressure symptoms, treatment with ¹³¹I preceded by recombinant human TSH is successful but causes hypothyroidism in varying degrees. This treatment can lead to 45-65% shrinkage of the MNG, even if in an intrathoracic position, with a relatively low cost, thus it is considered a good alternative to surgery. However, surgery is an acceptable option. The efficacy of T4 treatment after surgery, to prevent regrowth, is debatable although frequently usedt. For complete coverage of all related aeas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.

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