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‘It is assumed that most elderly patients with subclinical hyperthyroidism have a multinodular goiter, but several other conditions should be considered in the differential diagnosis.' With the expert care provided at Roswell Park, most patients who have a goiter or benign thyroid nodules will have an excellent chance of returning to good health, free of thyroid-related symptoms. Thyroid diseases, whether functional (hypothyroidism, hyperthyroidism ) or structural ( nodule , goiter, cancer ), are very common in both women and men.

Preferred in patients with signs and symptoms of anterior neck compression; patients with coexisting thyroid nodules in which there is a risk of malignancy; patients with hyperparathyroidism; patients with a large goiter (>80 grams) or those with retrosternal or substernal extension; and patients who require rapid correction of the hyperthyroid state. In people with goiter, the thyroid gland produces normal amounts of thyroid hormones, so people do not have hypothyroidism or hyperthyroidism. If you have a toxic multinodular goiter, which makes too much thyroid hormone, you might have symptoms of hyperthyroidism These include:

( 17 ) Hyperthyroidism can sometimes be caused by a nodular goiter, which causes the thyroid to produce excessive amounts of thyroid hormones. Patients with a toxic multinodular goiter may have signs and symptoms of hyperthyroidism. Other types of thyroiditis causing goiter include: 1. painless (postpartum) thyroiditis, a self-limited inflammation of the thyroid that can resolve without treatment and affects at least five per cent of women in the year after pregnancy; 2. subacute thyroiditis, which causes painful thyroid enlargement as the result of viral infection; and 3. other rarer forms of infectious thyroiditis; and 4. drug-induced thyroiditis, such as those caused by amiodarone and interferon alfa; and 5. a rare fibrosing condition called Reidel thyroiditis.

Certain drugs can also interfere with normal thyroid function and lead to compensatory gland enlargement, such as lithium carbonate, which causes a goiter in 10% of individuals taking this medicine. A goitrous gland can continue producing the proper amounts of thyroid hormones, in which case it is called a euthyroid or nontoxic goiter; or a goiter can develop in conditions with either overproduction of thyroid hormone, called toxic goiter, or the inability to make sufficient thyroid hormones, called goitrous hypothyroidism. Thyroid gland enlargement can be generalized and smooth, a so called diffuse goiter; or it can become larger due to growth of one or more discrete lumps (nodules) within the gland, a nodular goiter.

Romanchishen AF, Iakovlev PN. Special surgical treatment of patients with nodular tumors of the thyroid gland against the background of diffuse toxic goiter. Toxic nodular goiter, an enlarged thyroid gland that has a small, rounded growth or many growths called nodules, which produce too much thyroid hormone. This slideshow covers common symptoms, causes, and treatments of thyroid goiters.

A more common cause of goiter in America is an increase in thyroid stimulating hormone (TSH) in response to a defect in normal hormone synthesis within the thyroid gland. If the goiter is due to hyperthyroidism, the treatment will depend upon the cause of the hyperthyroidism (see Hyperthyroidism and Graves' disease brochures ). For some causes of hyperthyroidism, the treatment may lead to a disappearance of the goiter. A study of patients in our clinic with carcinoma of the thyroid and nontoxic nodular goiter has convinced us that numerous complications (including particularly the two just mentioned) developing in this type of goiter may make surgical therapy quite urgent in this seemingly harmless lesion.

Reduction in goiter size by 131I therapy in patients with non-toxic multinodular goiter. The use of fine-needle aspiration biopsy under ultrasound guidance to assess the risk of malignancy in patients with a multinodular goiter. In patients with diffuse nontoxic goiters treated with 131I, permanent hypothyroidism occurs in 14% after 1 yr ( 259 , 260 ), whereas long-term follow-up data are not available.

Fractionated therapy can be given to outpatients and might be an option in large goiters ( 256 ). However, the doses should probably be given with wide intervals to rule out thyroid stunning ( 257 ), which makes this treatment modality even more cumbersome.

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