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Multinodular Goiter
H. Ric Harnsberger, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Top Differential Diagnoses

        • Pathology

          • Clinical Issues

            • Diagnostic Checklist

              TERMINOLOGY

              • Abbreviations

                • Multinodular goiter (MNG)
              • Synonyms

                • Simple nodular goiter, nontoxic goiter
              • Definitions

                • Diffuse, multinodular enlargement of thyroid gland in response to chronic TSH stimulation
                • Retrosternal goiter: MNG extends to mediastinum

              IMAGING

              • General Features

                • Radiographic Findings

                  • CT Findings

                    • MR Findings

                      • Ultrasonographic Findings

                        • Nuclear Medicine Findings

                          • Imaging Recommendations

                            DIFFERENTIAL DIAGNOSIS

                              PATHOLOGY

                              • General Features

                                • Gross Pathologic & Surgical Features

                                  • Microscopic Features

                                    CLINICAL ISSUES

                                    • Presentation

                                      • Demographics

                                        • Natural History & Prognosis

                                          • Treatment

                                            DIAGNOSTIC CHECKLIST

                                            • Consider

                                              • Image Interpretation Pearls

                                                Selected References

                                                1. Bombil I et al: Incidental cancer in multinodular goitre post thyroidectomy. S Afr J Surg. 52(1):5-9, 2014
                                                2. Brito JP et al: Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. Thyroid. 23(4):449-55, 2013
                                                3. Darrat I et al: Novel DICER1 mutation as cause of multinodular goiter in children. Head Neck. Epub ahead of print, 2013
                                                4. Teshiba R et al: Identification of a KEAP1 germline mutation in a family with multinodular goitre. PLoS One. 8(5):e65141, 2013
                                                5. Luo J et al: Are there predictors of malignancy in patients with multinodular goiter? J Surg Res. 174(2):207-10, 2012
                                                6. Abboud B et al: Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck. 32(6):744-9, 2010
                                                7. Erdem G et al: Diffusion-weighted images differentiate benign from malignant thyroid nodules. J Magn Reson Imaging. 31(1):94-100, 2010
                                                8. Zhang B et al: Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. Thyroid. 20(1):51-7, 2010
                                                9. Fast S et al: Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy. Eur J Endocrinol. 160(4):517-28, 2009
                                                10. Agarwal G et al: Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 32(7):1313-24, 2008
                                                11. Moalem J et al: Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg. 32(7):1301-12, 2008
                                                12. Porterfield JR Jr et al: Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg. 32(7):1278-84, 2008
                                                13. Krohn K et al: Molecular pathogenesis of euthyroid and toxic multinodular goiter. Endocr Rev. 26(4):504-24, 2005
                                                14. Pollard DB et al: Preoperative imaging of thyroid goiter: how imaging technique can influence anatomic appearance and create a potential for inaccurate interpretation. AJNR Am J Neuroradiol. 26(5):1215-7, 2005
                                                15. Chin SC et al: Spread of goiters outside the thyroid bed: a review of 190 cases and an analysis of the incidence of the various extensions. Arch Otolaryngol Head Neck Surg. 129(11): 1198-202, 2003
                                                16. Hedayati N et al: The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 68(3): 245-51; discussion 251-2, 2002
                                                17. Lee CC et al: Imaging of huge lingual thyroid gland with goitre. Neuroradiology. 40(5): 335-7, 1998
                                                18. Netterville JL et al: Management of substernal goiter. Laryngoscope. 108(11 Pt 1): 1611-7, 1998
                                                19. Yousem DM et al: Clinical and economic impact of incidental thyroid lesions found with CT and MR. AJNR Am J Neuroradiol. 18(8): 1423-8, 1997
                                                20. Singh B et al: Substernal goiter: a clinical review. Am J Otolaryngol. 15(6):409-16, 1994
                                                21. Cooper JC et al: The use of computed tomography in the evaluation of large multinodular goitres. Ann R Coll Surg Engl. 73(1): 32-5, 1991
                                                22. Bashist B et al: Computed tomography of intrathoracic goiters. AJR Am J Roentgenol. 140(3):455-60, 1983
                                                Related Anatomy
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                                                Related Differential Diagnoses
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                                                References
                                                Tables

                                                Tables

                                                KEY FACTS

                                                • Terminology

                                                  • Imaging

                                                    • Top Differential Diagnoses

                                                      • Pathology

                                                        • Clinical Issues

                                                          • Diagnostic Checklist

                                                            TERMINOLOGY

                                                            • Abbreviations

                                                              • Multinodular goiter (MNG)
                                                            • Synonyms

                                                              • Simple nodular goiter, nontoxic goiter
                                                            • Definitions

                                                              • Diffuse, multinodular enlargement of thyroid gland in response to chronic TSH stimulation
                                                              • Retrosternal goiter: MNG extends to mediastinum

                                                            IMAGING

                                                            • General Features

                                                              • Radiographic Findings

                                                                • CT Findings

                                                                  • MR Findings

                                                                    • Ultrasonographic Findings

                                                                      • Nuclear Medicine Findings

                                                                        • Imaging Recommendations

                                                                          DIFFERENTIAL DIAGNOSIS

                                                                            PATHOLOGY

                                                                            • General Features

                                                                              • Gross Pathologic & Surgical Features

                                                                                • Microscopic Features

                                                                                  CLINICAL ISSUES

                                                                                  • Presentation

                                                                                    • Demographics

                                                                                      • Natural History & Prognosis

                                                                                        • Treatment

                                                                                          DIAGNOSTIC CHECKLIST

                                                                                          • Consider

                                                                                            • Image Interpretation Pearls

                                                                                              Selected References

                                                                                              1. Bombil I et al: Incidental cancer in multinodular goitre post thyroidectomy. S Afr J Surg. 52(1):5-9, 2014
                                                                                              2. Brito JP et al: Prevalence of thyroid cancer in multinodular goiter versus single nodule: a systematic review and meta-analysis. Thyroid. 23(4):449-55, 2013
                                                                                              3. Darrat I et al: Novel DICER1 mutation as cause of multinodular goiter in children. Head Neck. Epub ahead of print, 2013
                                                                                              4. Teshiba R et al: Identification of a KEAP1 germline mutation in a family with multinodular goitre. PLoS One. 8(5):e65141, 2013
                                                                                              5. Luo J et al: Are there predictors of malignancy in patients with multinodular goiter? J Surg Res. 174(2):207-10, 2012
                                                                                              6. Abboud B et al: Morbidity and mortality of thyroidectomy for substernal goiter. Head Neck. 32(6):744-9, 2010
                                                                                              7. Erdem G et al: Diffusion-weighted images differentiate benign from malignant thyroid nodules. J Magn Reson Imaging. 31(1):94-100, 2010
                                                                                              8. Zhang B et al: Utility of contrast-enhanced ultrasound for evaluation of thyroid nodules. Thyroid. 20(1):51-7, 2010
                                                                                              9. Fast S et al: Time to reconsider nonsurgical therapy of benign non-toxic multinodular goitre: focus on recombinant human TSH augmented radioiodine therapy. Eur J Endocrinol. 160(4):517-28, 2009
                                                                                              10. Agarwal G et al: Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. 32(7):1313-24, 2008
                                                                                              11. Moalem J et al: Treatment and prevention of recurrence of multinodular goiter: an evidence-based review of the literature. World J Surg. 32(7):1301-12, 2008
                                                                                              12. Porterfield JR Jr et al: Evidence-based management of toxic multinodular goiter (Plummer's Disease). World J Surg. 32(7):1278-84, 2008
                                                                                              13. Krohn K et al: Molecular pathogenesis of euthyroid and toxic multinodular goiter. Endocr Rev. 26(4):504-24, 2005
                                                                                              14. Pollard DB et al: Preoperative imaging of thyroid goiter: how imaging technique can influence anatomic appearance and create a potential for inaccurate interpretation. AJNR Am J Neuroradiol. 26(5):1215-7, 2005
                                                                                              15. Chin SC et al: Spread of goiters outside the thyroid bed: a review of 190 cases and an analysis of the incidence of the various extensions. Arch Otolaryngol Head Neck Surg. 129(11): 1198-202, 2003
                                                                                              16. Hedayati N et al: The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 68(3): 245-51; discussion 251-2, 2002
                                                                                              17. Lee CC et al: Imaging of huge lingual thyroid gland with goitre. Neuroradiology. 40(5): 335-7, 1998
                                                                                              18. Netterville JL et al: Management of substernal goiter. Laryngoscope. 108(11 Pt 1): 1611-7, 1998
                                                                                              19. Yousem DM et al: Clinical and economic impact of incidental thyroid lesions found with CT and MR. AJNR Am J Neuroradiol. 18(8): 1423-8, 1997
                                                                                              20. Singh B et al: Substernal goiter: a clinical review. Am J Otolaryngol. 15(6):409-16, 1994
                                                                                              21. Cooper JC et al: The use of computed tomography in the evaluation of large multinodular goitres. Ann R Coll Surg Engl. 73(1): 32-5, 1991
                                                                                              22. Bashist B et al: Computed tomography of intrathoracic goiters. AJR Am J Roentgenol. 140(3):455-60, 1983