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In a controlled trial, performed in an iodine-deficient area, a daily dose of 400 μg iodine during 8 months was as effective as 150 μg l-T4 in reducing the size of diffuse goiter ( 211 ). A major hindrance in the use of iodine supplementation, however, is the fact that a sudden increase of the iodine intake may induce thyrotoxicosis in predisposed individuals ( 212 , 213 ). Of further concern is that iodine supplementation appears to increase the incidence of papillary thyroid cancers and lymphoid thyroiditis ( 214 ). Due to these drawbacks, iodine supplementation in the context of nodular goiters is disregarded as an option, both in Europe (except in Germany) and in North America ( 8 , 9 ). This leaves in essence three kinds of therapy: l-T4 suppressive therapy, surgery, and 131I therapy. Due to this effect on gland volume, 131I has been used during the last two decades in the treatment of compressive nontoxic nodular goiters, but in most countries, 131I is restricted to hyperthyroid patients ( 8 , 9 ). With one exception ( 224 ), all studies dealing with the effect of 131I therapy on goiter reduction lack a control group. For example, in nodules larger than 10 mm, the prevalence of cancer is unrelated to whether they can be detected by palpation ( 203 ). The possibility of thyroid malignancy should be considered in all patients with multinodular goiters, and the use of US guidance has been shown to enhance the diagnostic efficacy of FNAB ( 204 ). It has been recommended that nodules less than 10 mm, www.agenqncjellygamat.com detected incidentally, do not require a FNAB ( 61 , 126 ). However, in the recent study by Papini et al. ( 205 ), thyroid malignancy was found in 6% of nonpalpable lesions of 8-15 mm in size in multinodular goiters (9% in solitary thyroid nodules).

A goiter or enlarged thyroid may be the result of; an autoimmune disease, such as Hashimoto's disease or Graves disease; iodine deficiency or medication such as lithium; inflammatory conditions such as multinodular goiter, solitary thyroid nodules or thyroid cancer. Goiter is any abnormal enlargement of the thyroid gland The condition has various causes, with the most common worldwide being iodine deficiency. The enlarged thyroid may or may not have another type of structural thyroid problem called thyroid nodules Patients with goiters can also have functional thyroid problems , so there are two types of goiters: Non-Toxic Goiter and Toxic Multinodular Goiter.

Multinodular goiters can be either a toxic multinodular goiter (i.e. makes too much thyroid hormone and causes hyperthyroidism. On the other hand, diffuse or focal lymphocytic infiltrates in an enlarged gland may represent chronic autoimmune thyroiditis and not merely simple goiter ( 4 ). This can be confirmed by fine-needle aspiration biopsy (FNAB), and subsequently, l-T4 therapy may be considered in these cases, particularly if the serum TSH level is located in the upper normal range. The presence of discomfort in the neck, jaw, or ear and dysphagia, hoarseness, or dyspnea can occur in patients with benign thyroid nodules, particularly in those with large multinodular goiters, but may also indicate thyroid carcinoma.

In a 20-yr follow-up study of 11- to 18-yr-old subjects in the southwestern United States, 60% of the 92 subjects who had diffuse goiters initially had spontaneous regression by the age of 30 yr ( 67 ). In a large epidemiological study, Knudsen et al. ( 51 ) only found an increase of thyroid volume up to the age of 40 yr. On the basis of cross-sectional data and ultrasonic scanning, an average annual growth rate of 4.5% in multinodular goiter has been reported ( 68 ). In patients referred because of SNG and who qualified for treatment, it has been estimated to be up to 20% yearly in a noniodine-deficient region ( 69 ) but is usually much lower. However, patients may present with hyperthyroidism or hypothyroidism Large goiters may also cause obstructive symptoms due to compression of the trachea and/or the esophagus.