Goiter consists of an enlargement of the thyroid gland, located on the front of the neck, butterfly-shaped and resting on the trachea. This growth can be uniform, diffuse goiter, or associated with the appearance of one or more nodules, nodular or multinodular goiter.
Multinodular goiter is a very frequent pathology, caused by different reasons: iodine deficiency, intake of goitrogenic foods (such as cauliflower, Brussels sprouts, nuts, etc.), drugs (such as perchlorates, colchicine, thiocyanate), congenital defects and autoimmune phenomena.
Symptoms of multinodular goiter
In its initial stages, multinodular goiter is usually asymptomatic, but the progressive growth of the nodules causes them to present symptoms of compression: dysphagia, occurs when it is performed on the esophagus; dyspnea, on the trachea; dysphonia, due to compression of the recurrent laryngeal nerves, which act on the vocal cords. In most cases thyroid function is preserved, but in advanced stages it may be altered with the appearance of hypothyroidism or hyperthyroidism.
Diagnosis of multinodular goiter
Given its scarce clinical study, its diagnosis is usually accidental, after an exploration of the neck or the performance of a cervical ultrasound for other reasons.
The diagnostic test par excellence is cervical ultrasound, which describes the number, size, appearance and characteristics of the thyroid nodules, as well as the presence of associated cervical lymphadenopathy, which would suggest malignancy. Other tests used in the study of goiter are: scintigraphy, CT or MRI.
The Fine Needle Aspiration Puncture (FNA) method allows to know the nature of the nodule. It is recommended to perform it under ultrasound control, which makes it possible to puncture the most suspicious nodule. It should be remembered that a multinodular goiter is associated with thyroid cancer in 5% of cases.
Treatment of multinodular goiter
The definitive treatment in General Surgery for multinodular goiter is surgical treatment, but not all multinodular goiters require surgery. The indications are: suspicion of malignancy, compressive symptoms, endothoracic growth, functional alteration or infantile age.
The surgical technique to be performed is total thyroidectomy, in which the entire thyroid gland is removed and, therefore, the disease. It is a delicate surgery due to the existence of structures of vital importance for the voice, laryngeal nerves, or for calcium metabolism, parathyroid, which must be respected. It is therefore recommended that this surgery be performed by experts in this field. This surgery entails the need for lifelong replacement therapy, which is generally well tolerated by the patient.