Comparison and contrast of surgical and medical treatment for adult patients (age 20 and older) with multinodular goiter

Thumbnail Image
Issue Date
Kouneva-Skerleva, Velitchka
Bunton, Patricia A.

Multinodular nontoxic goiter is defined as a benign enlargement of the thyroid gland in a subject living in an iodine insufficient area. The causes of MNG are not completely understood, but include autoimmune, genetic, and extrinsic factors. Symptoms vary widely among patients, from those with no symptoms and an incidentally discovered goiter to those with tracheal compression and stridor. The treatment goals for patients with a benign MNG include relief of local compressive symptoms or cosmetic deformity, prevention of progressive thyroid enlargement, and treatment of associated thyroid dysfunction. There are three main treatment options for MNG: thyroidectomy, levothyroxine suppression, and radioactive iodine.

Methodology: The purpose of this paper was to compare and contrast medical versus surgical treatment of patients with multinodular goiter through a systemic review of the literature, so that primary care practitioners can use evidence-based criteria when treating or recommending treatment. Articles from 1975 to the present were reviewed that included adult patients ranging in age from twenty years old and older who were diagnosed with benign MNG. Variables included thyroidectomy, antithyroid suppressive therapy and radioiodine therapy.

Results: Twenty articles matched the criteria and were reviewed using evidence-based methods. After close analysis of the presented data, disagreement remains in the current treatment of asymptomatic MNG and no optimum treatment has been established.

Conclusion: There still is considerable controversy about the optimum treatment and efficacy of using different suppressive medications versus surgical treatment for patients with asymptomatic MNG. Treatment decisions for nontoxic multinodular goiter must be individualized and based on the clinical examination and adequate follow up.

Table of Content
A project presented to the Department of Physician Assistant of Wichita State University in partial fulfillment of the requirements for the degree of Master of Physician Assistant.