Hurley and Gharlib listed criteria for the management of a patient with a multinodular goiter. The authors are from the Mayo Clinic in Rochester, Minnesota.


Management modalities:

(1) annual monitoring

(2) surgical resection

(3) treatment with radioactive iodine


Indications for definitive management:

(1) evidence of hyperthyroidism

(2) compression syndrome

(3) cosmesis

(4) concern about malignancy


Annual monitoring (with TSH levels) is indicated if:

(1) the goiter is small or modest in size

(2) the patient is euthyroid with normal TSH

(3) clinically asymptomatic without signs of compression syndrome

(4) fine needle aspiration (FNA) cytology of all suspicious nodules is benign


Radioactive iodine may be given if:

(1) the patient is unable or unwilling to undergo surgery

(2) the symptoms are not serious enough to require immediate relief


For all other situations surgical resection is the treatment of choice.


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