Medical Treatment

Although thyroid hormone administration may be beneficial "suppressive therapy" for diffuse colloid goiter, once nodule formation has developed, patients are unlikely to benefit.67-68 TSH suppression with exogenous T4 may also reduce the size of some malignant nodules.69 This clearly underscores the problem of potential misdiagnosis for the unwary when using this therapy as a nonoperative management of thyroid nodular disease.

Toxic nodular goiter (Plummer's disease) may identify a toxic nodule (or at least ascertain the side of activity) with radioiodine scanning and surgery is usually recommended if the nodule is greater than 3 cm diameter or symptomatic. Radioiodine treatment for toxic multinodular goiter usually requires higher or repeated doses than for Graves' disease, but toxic solitary nodule (toxic adenoma) is usually well controlled by a single treatment, although radioiodine may not diminish nodule size. One follow-up study has demonstrated that 50% remain unchanged and 10% actually increased in size.70 Where the patient has symptomatic pressure symptoms and the goiter is relatively large, radioiodine does not relieve local symptoms and surgery is indicated, almost certainly if the nodule is larger than 3 cm in diameter. However, radioiodine may be indicated for elderly patients or those with a significant risk of general anesthesia.

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