What is a multinodular goiter? — A multinodular goiter is a swelling in the neck. It is caused by abnormal growth of the thyroid gland, plus one or more growths called "thyroid nodules." Thyroid nodules are round or oval-shaped growths in the thyroid gland (figure 1). The thyroid gland is in the middle of the neck.
Thyroid nodules are common and not usually harmful to a person's health. But sometimes thyroid nodules are caused by a serious condition, such as cancer.
The thyroid gland makes a hormone called "thyroid hormone." Most thyroid nodules do not change the amount of thyroid hormone in the body. But some thyroid nodules cause the thyroid gland to make too much thyroid hormone. If a multinodular goiter has this type of thyroid nodules, it can cause symptoms.
What are the symptoms of a multinodular goiter? — Most people with a multinodular goiter do not have symptoms. The swelling might be found during an imaging test, such as an ultrasound, that is done for another reason. Or a blood test to check thyroid hormone levels might show that a person has too much thyroid hormone. Having too much thyroid hormone can be a sign of a multinodular goiter.
Some people with a multinodular goiter feel or see a lump in their neck. Or they have symptoms from having too much thyroid hormone, such as:
Feeling worried or upset, or having trouble sleeping
Feeling weak or tired
Losing weight without trying
Having a fast heartbeat
Having frequent bowel movements
If a multinodular goiter presses on the throat or airway, it can cause:
Trouble breathing – Especially during physical activity, at night, or when reaching or bending
A choking feeling
Will I need tests? — Yes. Your doctor will want to make sure that the multinodular goiter is not going to harm your body. You need tests to find out if nodules in the goiter are causing your thyroid gland to make too much hormone. Your doctor will also check the nodules to see how big they are and if they need to be taken out.
Tests usually include blood tests and an imaging test of the thyroid called an ultrasound. This test uses sound waves to create a picture of the inside of your body.
Sometimes, people need more tests. These include:
Fine needle aspiration – For this test, a doctor uses a thin needle to remove a small sample of tissue from one nodule in the goiter, usually the largest. They might take tissue from more than one nodule. Then, another doctor looks at the tissue under a microscope.
Thyroid scan – People get this test only if they have too much thyroid hormone in the body. For this test, a person gets a pill or a shot with a small amount of a radioactive substance. Then a special camera takes a picture of the thyroid gland. This test is not safe for women who are pregnant or breastfeeding.
How is a multinodular goiter treated? — Many multinodular goiters do not need treatment. If the nodules are small and do not look harmful, your doctor might watch and wait to see if the swelling gets bigger or needs to be treated.
A multinodular goiter needs treatment if:
It causes the thyroid gland to make too much hormone
It causes problems with breathing, swallowing, or other body functions – or is very large
It contains cancer
Treatments for multinodular goiter include:
Antithyroid medicines – If your thyroid blood tests show that the thyroid gland is making too much thyroid hormone, doctors can use medicines such as methimazole (MMI) (brand name: Tapazole) and propylthiouracil (also called "PTU") to lower the amount of thyroid hormone it makes. These medicines control thyroid hormone levels until doctors can do other treatments.
Medicines to help with symptoms caused by too much thyroid hormone, such as atenolol (brand name: Tenormin)
Surgery to remove the multinodular goiter
Radioactive iodine – Radioactive iodine comes in a pill or liquid that you swallow. It has a small amount of radiation in it. The radiation treats the problem by destroying a lot of the thyroid gland, so it does not make so much hormone. Radioactive iodine is used only to treat nodules that make too much thyroid hormone. It is not safe for women who are pregnant or breastfeeding.
Injections of alcohol to shrink nodules, or laser treatment to destroy them. The alcohol used in this treatment is not the kind people drink.
What if I want to get pregnant? — If you want to get pregnant, talk with your doctor or nurse. They can make sure your multinodular goiter is not making too much thyroid hormone before you get pregnant.
Women who are pregnant should not be treated with radioactive iodine. This is because radioactive iodine can cause serious harm to a baby.
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This topic retrieved from UpToDate on: Mar 30, 2020.
Topic 17222 Version 5.0
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