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Treatment of Multinodular Goiter vs. Other Types of Goiters

Goiter is an all-encompassing term that refers to a thyroid that is enlarged for any reason. Goiter can either be simple or multinodular. A simple goiter can occur without any known reason. There are times, though, when the growth is caused by the lack of iodine in one’s diet. Without enough iodine, the thyroid is unable to produce the sufficient amount of hormones required by the body. To compensate and meet the body’s demands, the thyroid grows larger. This disease is common in females, people over 40, and people with a family history of goiter.

Multinodular goiter is an enlarged thyroid gland with many growths called nodules. One or more of these nodules produces too much of the thyroid hormones and causes hyperthyroidism. Also called toxic nodular goiter, this disease is prevalent in females and people over the age of 60. It is rarely seen in children. Many of the patients who develop this disease have had goiter for years.

Difference in Treatment

A goiter is only treated if it is causing symptoms. A simple goiter may disappear by itself, continue to grow overtime, or stop producing thyroid hormones altogether.

There are four ways of treating the problems caused by simple goiter.

  1. Thyroid hormone replacement pills – This treatment is recommended if the enlarged thyroid has stopped producing thyroid hormones and the patient begins to experience the symptoms of hypothyroidism. Thyroid hormone replacement pills make up for the lack of naturally produced thyroid hormones in the body.
  2. Lugol's iodine or potassium iodine solution – If the thyroid enlargement is caused by the lack of iodine in the body, then it is treated by introducing small doses of Lugol's iodine or potassium iodine solution to the patient’s system.
  3. Radioactive iodine treatment – If the enlarged thyroid is producing too much hormones, radioactive iodine treatment is used shrink it.
  4. Surgery or thyroidectomy may also be employed to remove the thyroid if it is too large, causing symptoms, or is cosmetically unappealing.

Multinodular goiter, on the other hand, can cause concern for cancer, especially if the goiter has a dominant nodule that produces too much thyroid hormones. Because of this, multinodular goiter may require a thyroid uptake and scan test, a thyroid ultrasound, and further testing of the thyroid hormone and thyroid stimulating hormone levels.

Treatment for multinodular goiter may include any of the following:

  1. Antithyroid drugs – This treatment is commonly used by endocrinologists to address the hyperthyroidism that accompanies overactive and enlarged thyroid nodules. The goal of antithyroid medication is to prevent the thyroid from producing too much T4 and T3 hormones. Propylthiouracil (PTU) and methimazole are 2 known antithyroid medications in the US.
  2. Radioactive iodine treatment – Radioactive iodine treatment can destroy part or the entirety of the thyroid. Most of the time, though, multinodular goiter calls for the total destruction of the thyroid gland.
  3. Surgery or thyroidectomy –This treatment is not commonly used for hyperthyroidism. However, if the thyroid is very large or the nodules may be concerning for suspicion of cancer, the patient may have to undergo thyroidectomy.

The patient may also take beta-blockers or propranolol to control hyperthyroidism until hormone production is normal again.

If you are searching for endocrinologists who can help you diagnose and treat your goiter or any other endocrine condition, please don’t hesitate to get in touch with Providence Saint John’s Health Center. Our Endocrine Tumor and Bone Disease Program is led by physician-scientists Dr. Melanie Goldfarb and Dr. Frederick Singer, who are both renowned clinicians in addition to being distinguished for their research and work as faculty members of the John Wayne Cancer Institute.

Our hospital is located in the city of Santa Monica, California, serving patients from surrounding communities and from other U.S. locations.

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