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Nontoxic Multinodular Goiter

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The Thyroid and Its Diseases

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Abstract

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.

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Authors and Affiliations

  1. Genome Sciences Department, The Australian National University, Canberra, ACT, Australia

    Gilberto Paz-Filho

  2. SEMPR—Endocrinology Division, Federal University of Parana, Curitiba, Brazil

    Hans Graf

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  1. Gilberto Paz-Filho
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  1. Department of Nuclear Medicine, Philipps University Marburg, Marburg, Germany

    Markus Luster

  2. Unit of Endocrinology Diabetes and Metabolism, Evgenidion Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Leonidas H. Duntas

  3. Georgetown University School of Medicine, Washington, DC, USA

    Leonard Wartofsky

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Paz-Filho, G., Graf, H. (2019). Nontoxic Multinodular Goiter. In: Luster, M., Duntas, L., Wartofsky, L. (eds) The Thyroid and Its Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-72102-6_34

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