The Role of Medical Management for Nodular Hyperthyroidism

  • Ana E. Espinosa De Ycaza
  • Marius N. StanEmail author


Toxic multinodular goiter (TMNG) and autonomously functioning thyroid nodules (AFTN) are common causes of hyperthyroidism. We discuss the nonsurgical management of TMNG and AFTN.

Radioactive iodine (RAI) is the most commonly used medical therapy for TMNG and AFTN with overall high cure rates. Antithyroid drugs (ATDs) are used often in preparation for RAI and should be considered in the elderly, in those with severe hyperthyroidism, or in individuals with cardiac comorbidities in which exacerbation of hyperthyroidism could have adverse outcomes.

Other medical therapies such as thermal ablation (for AFTN only) or long-term therapy with ATDs can be considered in special circumstances.

Radiofrequency ablation (RFA) and percutaneous laser ablation (PLA) have been used for more than 10 years, and they appear to be safe. RFA and PLA are effective in reducing the size of the nodule and control of hyperthyroidism in more than half of treated cases. While surgery and RAI are still the standard therapeutic options for TMNG and AFTN, both RFA and PLA are increasingly being used in patients with AFTN where both surgery and RAI are not feasible or acceptable options. Future studies are needed to improve the classification of these patient subgroups, while technology will improve the efficacy, and health economics will improve the availability of ablative procedures throughout the world.

Percutaneous ethanol injection (PEI) into the nodule was an ablative therapy used in the 1980s–1990s. Ethanol can dissipate beyond the target with the occurrence of significant complications. Therefore, PEI is no longer considered an option for AFTN.


Toxic multinodular goiter Autonomously functioning thyroid nodules Toxic adenoma Marine-Lenhart syndrome Hyperthyroidism Antithyroid drugs Graves’ disease Radioactive iodine Percutaneous ethanol injection Radiofrequency ablation Percutaneous laser ablation 



Autonomously functioning thyroid nodule


Antithyroid drugs


Cardiovascular disease


Percutaneous ethanol injection


Percutaneous laser ablation


Radioactive iodine


Radiofrequency ablation


Toxic multinodular goiter


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© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Endocrinology, Diabetes, Metabolism and NutritionMayo ClinicRochesterUSA

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