Treatment of Symptomatic Benign Multinodular Goiter with Compressive Symptoms
This protocol applies to patients with multinodular goiter confirmed benign on cytology, normo-functioning (not hyperfunctioning), who are experiencing compressive or local symptoms caused by the goiter.
Clinical Scenario
Multinodular goiter, benign at cytology, normo-functioning (not hyperfunctioning), with compressive or local symptoms related to the goiter. Because function is normal and malignancy has been excluded cytologically, the management goal is symptom relief through volume reduction.
Treatment Approach
Radioactive iodine (RAI) is considered a non-surgical option in this setting, and may be favoured particularly when surgical risk is a concern. The full protocol details the conditions under which RAI, surgical, or ablative approaches are selected and sequenced — the complete decision pathway is available via the link below.
Treatment Goal
Reduction of thyroid volume by approximately 40% within 12 months, with alleviation of compression symptoms.
References
DOI: 10.1530/ETJ-23-0067
- Consider RAI as an alternative to surgery in benign normo-functioning multinodular goiter.
- When symptomatic and benign, thyroid nodules may, as an alternative to surgery, be eligible for RAI, especially in case of patients at surgical risk.
- RAI is most often given as a fixed activity, most often achieves euthyroidism, may cause hypothyroidism, and reduces nodule size by 30–50% in 12 months.
- In case of low RAI uptake and/or a large goiter, prestimulation with rhTSH has been demonstrated to augment thyroid volume reduction and improves pressure symptoms.
- Thyroid volume is typically reduced by 40% within 12 months and alleviates symptoms in most.
View source ↗