Radioiodine therapy of euthyroid multinodular goitres.

Euthyroid multinodular goitre is caused by excessive replication of thyroid epithelial cells, due to various stimuli. With time there is a gradual increase in size and in nodularity. The clinical manifestations arise solely from thyroid enlargement. Treatment of euthyroid multinodular goitre is indicated only when thyroid enlargement causes symptoms of obstruction, such as dysphagia and dyspnoea. Treatment options are radioiodine (iodine-131), surgery and TSH suppression therapy. In this review we compare these treatment modalities. In our opinion, radioiodine is the treatment of choice in elderly patients, in patients in whom surgery is contra-indicated and in patients who are unwilling to undergo surgery. The life-time risk of fatal and non-fatal cancer due to radioiodine is negligible in patients over 65 years of age, compared with the life-time risk of fatal cancer in the non-exposed population.