Table 6.7-2. Treatment of nontoxic multinodular goiter: advantages and disadvantages of various therapeutic options

Treatment method



Surgery (nodules suspicious for malignancy, tracheal compression)

Surgical complications; hospitalization required

Total removal of nodule; complete resolution of symptoms; histologic diagnosis

Radioiodine therapy (age >40-60 years, goiter volume >60 mL, contraindications to surgery; not commonly used)

Slow reduction in the goiter volume; hypothyroidism (10% in 5 years); radiation-induced thyroiditis (1%-2%); effective contraception required

Minor side effects; 40% reduction in goiter volume in 2 years

Percutaneous ethanol injections (subtoxic nodules, simple cysts; not commonly used)

Difficult evaluation of subsequent cytology; repeated injections necessary; ineffective in large nodules; painful procedure; transient dysphonia (1%-2%)

Does not cause hypothyroidism