Abstract
Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, neck tightness, and airway obstruction. In contrast, patients with such goiters who remain asymptomatic may be observed after exclusion of malignancy. The use of levothyroxine (LT4) to reduce the volume of the goiter is still a controversial treatment for large goiters, and the optimal surgical procedure for multinodular goiter is still debatable. Radioiodine is a safe and effective treatment option when used alone or in combination with recombinant human TSH. This review discusses current therapeutic options to treat diffuse and multinodular non-toxic benign goiters.
Highlights
Once the diagnosis of non-toxic diffuse goiter (NDG) or non-toxic nodular goiter (NNG) is established, the following management goals should be considered: a
The expression of the progressive and nodular increase of the thyroid in non-toxic benign goiters is the result of a combination of genetic and environmental factors, of which iodine deficiency is the most important [1]
In a randomized placebo-controlled trial, a ≥25% goiter volume reduction was seen in 58% of the individuals with NNG and NDG during LT4 suppressive therapy over 9 months, with a return to the original volume after treatment withdrawal
Summary
Thyroid Unit, Division of Endocrinology and Metabolism, University of São Paulo Medical School, Hospital das Clínicas, São Paulo, Brazil. Reviewed by: Salvatore Ulisse, Sapienza University of Rome, Italy Akira Hishinuma, Dokkyo Medical University, Japan. Patients with large benign goiters often present local compressive symptoms that require surgical treatment, including dysphagia, neck tightness, and airway obstruction. Patients with such goiters who remain asymptomatic may be observed after exclusion of malignancy. The use of levothyroxine (LT4) to reduce the volume of the goiter is still a controversial treatment for large goiters, and the optimal surgical procedure for multinodular goiter is still debatable. Radioiodine is a safe and effective treatment option when used alone or in combination with recombinant human TSH. This review discusses current therapeutic options to treat diffuse and multinodular nontoxic benign goiters
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