Toxic multinodular goiter medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sunny Kumar MD [2],Furqan M M. M.B.B.S[3]

Overview

The mainstay of treatment for Toxic multinodular goiter is Surgery. Patients with symptomatic hyperthyroidism, sub-clinical hyperthyroid patients with expected compilations and patients refusing surgical therapy are treated with beta blockers and anti-thyroid pharmacological groups.

Medical Therapy

Indications

Symptomatic therapy for toxic multinodular goiter (TMG) is recommended for the patients with the following:[1][2][3]

Pharmacological drug therapy

Following are drugs used in the symptomatic management of toxic multinodular goiter:

Following are antithyroid medicines used in the management of TMG:

Anti-thyroid therapy for toxic multinodular goiter (TMG) is recommended for the patients with the following:

Treatment of TMG should be decided on:

Drug Regimens

Pharmacological medical therapy for toxic multinodular goiter is primarily based on beta blockers and anti-thyroid drugs.[4]

  1. Toxic Multinodular Goiter
    • Hyperthyroidism[5]
    • Subclinical hyperthyroidism with comorbid conditions such as diabetes mellitus, heart failure or CNS abnormality[3]
      • Preferred regimen (1): Propylthiouracil 5-10 mg q24h PO for long term to avoid remission with 3 month review of TSH
      • Alternative regimen (1): Methimazole 5-10 mg q24h PO for long term to avoid remission with 3 month review of TSH
    • Subclinical hyperthyroidism without comorbid conditions
      • Preferred: Monitoring/Review of TSH every 3 month
      • Alternative regimen (1):Propylthiouracil 5-10 mg q24h PO for long term to avoid remission with review of TSH every 3 month

Ultrasound-Guided percutaneous ethanol injection (PEI):[6]


References

  1. 1.0 1.1 Laurberg P, Buchholtz Hansen PE, Iversen E, Eskjaer Jensen S, Weeke J (1986). "Goitre size and outcome of medical treatment of Graves' disease". Acta Endocrinol (Copenh). 111 (1): 39–43. PMID 3753814.
  2. name="pmid1283983">van Soestbergen MJ, van der Vijver JC, Graafland AD (1992). "Recurrence of hyperthyroidism in multinodular goiter after long-term drug therapy: a comparison with Graves' disease". J Endocrinol Invest. 15 (11): 797–800. doi:10.1007/BF03348807. PMID 1283983.
  3. 3.0 3.1 Becker DV, Hurley JR (1971). "Complications of radioiodine treatment of hyperthyroidism". Semin Nucl Med. 1 (4): 442–60. PMID 4107462.
  4. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL; et al. (2016). "2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis". Thyroid. 26 (10): 1343–1421. doi:10.1089/thy.2016.0229. PMID 27521067.
  5. van Soestbergen MJ, van der Vijver JC, Graafland AD (1992). "Recurrence of hyperthyroidism in multinodular goiter after long-term drug therapy: a comparison with Graves' disease". J Endocrinol Invest. 15 (11): 797–800. doi:10.1007/BF03348807. PMID 1283983.
  6. Felício JS, Conceição AM, Santos FM, Sato MM, Bastos Fde A, Braga de Souza AC; et al. (2016). "Ultrasound-Guided Percutaneous Ethanol Injection Protocol to Treat Solid and Mixed Thyroid Nodules". Front Endocrinol (Lausanne). 7: 52. doi:10.3389/fendo.2016.00052. PMC 4893597. PMID 27375551.

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