Symptoms and Treatment of Multinodular Goiter

Multinodular goiters are associated with a higher risk of thyroid cancer. Your doctor will most likely screen you for thyroid cancer if MNG is diagnosed.

March 9, 2018

Symptoms and Treatment of Multinodular Goiter

Goiter is an enlargement of the thyroid gland. When the thyroid gland have multiple growths or nodules leading to enlargement of the whole thyroid gland, it is termed as multinodular goiter (MNG). Multinodular goiter can be nontoxic or toxic. Multinodular goiters are associated with a higher risk of thyroid cancer. Your doctor will most likely screen you for thyroid cancer if MNG is diagnosed.
Treatment for multinodular goiter varies depending on:

  • the size of the goiter
  • whether you have hyperthyroidism
  • whether any of the nodules are cancerous

Symptoms of multinodular goiter:

Most multinodular goiters do not cause any symptoms and are discovered during a routine physical exam. If the size of the goiter is very small it will not have any symptoms. slow growing goiter are not noticeable.
But a multinodular goiter that grows large can cause symptoms, especially if it starts to grow into your chest. Symptoms of a large goiter include:

  • feeling of fullness in the neck
  • a choking sensation
  • difficulty swallowing large pills or chunky foods
  • a sense of pressure on the neck, or worsening snoring

Multinodular goitre can cause pain or discomfort when there is a rapid increase in size. This may be due to a sudden build-up of fluid or blood within a nodule or, due to a tumor which is very rare. Very large goiters might also be visible in your neck and require surgical removal when it will have symptoms of difficulty with swallowing or breathing .
A toxic multinodular goiter, which makes too much thyroid hormone, will have symptoms of hyperthyroidism. These include:

  • sudden and unexplained weight loss
  • rapid heartbeat
  • increased appetite
  • nervousness or anxiety
  • tremors, usually in your hands
  • sweating
  • increased sensitivity to heat

Treatment of multinodular goiter:

Noncancerous goiters that are not causing any symptoms does not require any treatment. In this case your doctor might suggest watching and waiting to see if the goiter is growing. If the goiter does grow very large or starts causing symptoms, there are several treatment options.
These include:

Radioactive iodine:

Multinodular goiters are often treated with radioactive iodine. Radioactive iodine can be taken either as a capsule or in liquid form, which is absorbed by your thyroid gland. This will result in shrinkage of the nodules and reducing the effect of hyperthyroidism. Usually the process takes two to three months to be effective. It works by destroying part of your thyroid to bring back thyroid hormone production levels to normal. There is always a risk of developing hypothyroidism after radioactive iodine therapy.

Anti-thyroid Medications:

Methimazole and propylthiouracil are medication options that are used to treat hyperthyroidism by decreasing the amount of thyroid hormone in your body. But this treatment can have serious side effects on your liver and it may take more time to be effective. Therefore it is important to discuss the risks and benefits of this treatment with your doctor before opting for it.


If the goiter has become very large or is causing any trouble with breathing or swallowing, some part or all of the thyroid gland can be removed. The amount of thyroid gland to be removed depends on different factors such as, how big the goiter is, how many nodules there are, if any nodules are toxic, or if there is cancer. You will need lifelong hormone replacement therapy with levothyroxine to supply your body with normal amounts of thyroid hormone if all of your thyroid gland is removed.
If any of the nodules are cancerous, surgery is recommended treatment. Suspicious nodules from biopsy also need surgical removal, so they can be examined for signs of cancer. Surgery should only be an option if treatment with radioactive iodine or anti-thyroid medications is not effective for a person. The overactive thyroid nodule can be removed in this case. The risks associated with surgery should be thoroughly discussed with your doctor before going for it.