Treatment of Multinodular Goiter with Hyperfunctioning Thyroid Nodules and Subnormal TSH

This protocol covers the management of multinodular goiter presenting in its toxic form — with autonomous hyperfunctioning thyroid nodules and a subnormal serum TSH level — a distinct clinical scenario that warrants a specific therapeutic approach.

Clinical Scenario

Toxic multinodular goiter with hyperfunctioning thyroid nodules and subnormal serum TSH. Surgery is one of the available therapeutic options for hyperfunctioning nodules and toxic multinodular goiter.

Treatment Approach (partial)

Radioactive iodine (RAI) therapy is an established option in this setting, with evidence for achieving euthyroidism and reducing nodule volume. Full selection criteria, alternative interventions, and the complete evidence-based algorithm are available in the protocol.

Clinical Goals

Reduction of nodule size by 30–50% within 12 months, with restoration of euthyroidism.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1530/ETJ-23-0067

Surgery is one of the available therapeutic options, besides RAI and MIT, for hyperfunctioning nodules and toxic multinodular goiter.

RAI is most often given as a fixed activity (e.g. 185–370 MBq), most often achieves euthyroidism, may cause hypothyroidism, and reduces nodule size by 30–50% in 12 months.

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