Medicines for Multinodular goitre

What it is

A multinodular goitre is an enlargement of the thyroid gland (a "goitre") that contains multiple nodules (lumps). It is a common condition, particularly in older people and women, and often develops slowly over many years. In many people it is simply an enlarged, lumpy thyroid that causes no symptoms and is noticed as a swelling in the neck or found incidentally. Most multinodular goitres are benign (non-cancerous). They can, however, cause issues in a few ways. First, they can affect thyroid function: while many have normal thyroid function, over time some multinodular goitres develop nodules that produce excess thyroid hormone, leading to an overactive thyroid (a "toxic" multinodular goitre) — this is a common cause of an overactive thyroid, especially in older people. Second, if the goitre becomes large, it can press on nearby structures in the neck, causing symptoms such as a visible neck swelling, a feeling of pressure or tightness, difficulty swallowing, and, occasionally, breathing difficulty or a change in the voice; sometimes a goitre extends down behind the breastbone. Third, as with any thyroid nodules, there is a small chance that a nodule within the goitre could be cancerous, so significant or suspicious nodules are assessed. Because of these possibilities, a multinodular goitre is assessed and monitored, and treated when needed.

How it is treated

A multinodular goitre is assessed to check thyroid function, evaluate the nodules, and determine whether any treatment is needed, and management is tailored to these findings. Assessment includes thyroid function blood tests, an ultrasound scan of the thyroid (to look at the nodules), and, where a nodule has concerning features, a fine-needle biopsy; scans may also assess the size and any extension of the goitre. Many multinodular goitres with normal thyroid function and no concerning features simply need monitoring over time. Treatment is considered in several situations: if the goitre causes an overactive thyroid, this is treated (for example with anti-thyroid medicines, radioactive iodine, or surgery); if the goitre is large and causing pressure symptoms (such as difficulty swallowing or breathing, or is cosmetically bothersome), it can be treated, most often with surgery to remove part or all of the thyroid, or sometimes radioactive iodine to shrink it; and if a nodule is found or suspected to be cancerous, it is treated appropriately by a specialist team. Where the thyroid is removed or becomes underactive after treatment, thyroid hormone replacement is given. Regular monitoring tracks the goitre and thyroid function. The reassuring message is that a multinodular goitre is common and usually benign, that it is assessed and monitored to check thyroid function and the nodules, and that effective treatments are available if it affects thyroid function, presses on the neck, or contains a concerning nodule.