Management of Simple Nodular Goiter: Current Status and Future Perspectives
Laszlo Hegedüs,
Steen J. Bonnema and
Finn N. Bennedbæk
Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000 Odense C, Denmark
Correspondence: Address all correspondence and requests for reprints to: Laszlo Hegedüs, M.D., D.M.Sc., Department of Endocrinology and Metabolism, Odense University Hospital, DK-5000 Odense C, Denmark. E-mail: laszlo.hegedus{at}ouh.fyns-amt.dk
The simple nodular goiter, the etiology of which is multifactorial,encompasses the spectrum from the incidental asymptomatic smallsolitary nodule to the large intrathoracic goiter, causing pressuresymptoms as well as cosmetic complaints. Its management is stillthe cause of considerable controversy.
The mainstay in the diagnostic evaluation is related to functionaland morphological characterization with serum TSH and (somekind of) imaging. Because malignancy is just as common in patientswith a multinodular goiter as patients with a solitary nodule,we support the increasing use of fine-needle aspiration biopsy(cytology).
Most patients need no treatment after malignancy is ruled out.In case of cosmetic or pressure symptoms, the choice in multinodulargoiter stands between surgery, which is still the first choice,and radioiodine if uptake is adequate. In addition to surgery,the solitary nodule, whether hot or cold, can be treated withpercutaneous ethanol injection therapy. If hot, radioiodineis the therapy of choice. Randomized studies are scarce, andthe side effects of nonsurgical therapy are coming into focus.Therefore, the use of the optimum option in the individual patientcannot at present be based on evidence. However, we are of theview that levothyroxine, although widely used, should no longerbe recommended routinely for this condition.
Within a few years, the introduction of recombinant human TSHand laser therapy may profoundly alter the nonsurgical treatmentof simple nodular goiter.
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