What is multinodular goiter?
We refer to the concept of multinodular goiter (MNB) when there is an enlargement of the thyroid gland containing one or more tumors called nodules. These nodules produce too much thyroid hormone.
The thyroid is located in front of the trachea, in the anterior cervical region and its function, to produce thyroid hormones, is essential for normal metabolic reactions and body functions.
Depending on the characteristics of the goiter it can be:
- Diffuse: at the expense of a general and regular increase of the gland.
- Nodular: there are focal increases in thyroid size, leading to the development of nodules.
If we look at the hormonal production of the goiter, it can be classified as follows:
- Normofunctioning: normal thyroid hormones.
- Hypofunctioning: low thyroid hormones.
- Hyperfunctioning: high thyroid hormones.
Prognosis of the disease
With adequate treatment the pathology does not usually cause major problems. The major complications that may occur are:
- Difficulty swallowing or breathing.
- Hyperthyroidism: goiter can lead to this pathology, which can cause muscle weakness, anxiety, thinness or irritability, among others.
- Problems associated with thyroid cancer.
Symptoms of multinodular goiter
Frequent symptoms of the pathology are:
- Lump in the central part of the neck, in the area in front of the trachea.
- The lump is usually elastic to palpation and mobile with swallowing movement.
- Depending on the size it may be more or less visible.
- When the size is voluminous it can cause discomfort when swallowing. In more serious cases it may cause difficulty in breathing.
- Aphonia.
Multinodular goiter may cause discomfort when swallowing.
Medical tests for multinodular goiters
The diagnosis is quick and simple and consists of:
- Cervical examination of the patient.
- Hormonal study.
- Ultrasound. In some cases a FNA (fine needle aspiration puncture) may be performed.
- MRI (in larger cases).
What are the causes of multinodular goiter?
Several causes can be distinguished that can lead to this pathology:
- Iodine deficiency: lack of iodine in the diet can cause the thyroid gland to form thyroid nodules. This is the main cause.
- Thyroid cyst: these are usually benign cysts, but may contain malignant solid components.
- Overgrowth of normal thyroid tissue: the cause of the lump is not clear but is usually not serious.
- Chronic thyroid inflammation (thyroiditis): this causes nodular enlargement.
Can it be prevented?
The main factor in multinodular goiter is a lack of iodine in the diet. This deficit can be prevented by adding meat and fish to the diet. Other basic foods containing iodine are bread and salt. The WHO recommends a daily intake of 100 to 150 micrograms.
Treatments for multinodular goiter
Treatment is usually based on monitoring the evolution of the goiter. In more severe cases or those producing a considerable esthetic defect, surgery may be performed. Surgery may also be recommended in cases where there is progressive growth or causes discomfort in speaking, breathing or swallowing.
Surgical treatment is also indicated in cases of suspected malignancy, as patients with goiter have a 5 to 10% chance of developing thyroid cancer. Also when there are symptoms of hyperthyroidism.
The most recommended surgery is total triodectomy, which removes both thyroid lobes and tries to preserve the parathyroid gland. This technique is preferred to bilateral subtotal triodectomy. In some cases it is necessary to reoperate a patient. In both techniques thyroid function is altered and the patient will need thyroid hormone supplementation.
What specialist treats it?
Multidular goiter is treated by specialists in Otolaryngology, General Surgery or Endocrinology.