Treatment of Multinodular Goiter: A Critical Review of Guidelines and Comparative Evidence (Published)
Multinodular goiter ranges from asymptomatic nodules to compressive enlargement or thyroid autonomy. This narrative review compares guidelines and selected comparative studies for adults with nontoxic and toxic disease. Thyroid function, malignancy risk, and compression determine the initial pathway. Observation is appropriate for selected asymptomatic, low-risk nontoxic disease. Surgery reduces tissue burden and provides a specimen for histology when obstruction or suspicious findings warrant it; symptom relief is assessed after recovery. Radioiodine offers gradual biochemical control and volume reduction in suitable patients. Thermal ablation addresses selected benign dominant nodules but does not treat the entire gland. In toxic disease, antithyroid medication controls hormone excess, while surgery and radioiodine offer definitive options with distinct anatomical and biochemical outcomes. Comparative evidence is limited by mixed populations, differing endpoints, and short follow-up for focal therapies. Decisions should identify the patient’s principal goal and account for anatomy, operative risk, replacement needs, and retreatment.
Keywords: Guidelines, multinodular goiter, radioiodine, thermal ablation, thyroidectomy, toxic multinodular goiter