Nontoxic Multinodular Goiter

  • Gilberto Paz-Filho
  • Hans GrafEmail author


Multinodular goiter (MNG), characterized as the nodular enlargement of the thyroid gland in the absence of inflammation, autoimmune thyroid disease, and malignancy, is a frequent thyroid disorder that affects women more frequently. Iodine deficiency is the most important etiological factor, but other environmental, hormonal, and genetic elements also play a role in its pathogenesis. Patients with MNG may be asymptomatic, but those more severely affected can develop compressive symptoms such as dysphonia, dysphagia, and respiratory insufficiency. Furthermore, the thyroid gland may develop autonomy and secrete thyroid hormones independent of TSH, leading to hyperthyroidism. The diagnostic workup includes thyroid hormone tests, imaging studies, evaluation of radioactive iodine uptake, pulmonary function tests, and fine-needle aspiration biopsy to exclude malignancy. The most accepted therapeutic approaches include clinical observation, surgery, and administration of radioactive iodine, which depend on the clinical presentation and on the patient’s preference. Novel therapeutical approaches, such as the use of radioiodine after circulating TSH is raised, either via the exogenous administration of recombinant human TSH or through the induction of transient primary hypothyroidism by antithyroid drugs, are being evaluated and may become available as alternative treatments.


Benign goiter Levothyroxine Multinodular Nodule Nontoxic Radioiodine Surgery 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Genome Sciences DepartmentThe Australian National UniversityCanberraAustralia
  2. 2.SEMPR—Endocrinology Division, Federal University of ParanaCuritibaBrazil

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