Multinodular goiter.

MNG is a common clinical problem. Though most goiters are benign and asymptomatic, they may cause concern when they create compressive symptoms, develop autonomous functioning nodules, or form suspicious nodules. Diagnostic evaluation should include clinical evaluation, laboratory tests including TSH, and consideration of additional evaluation and imaging when there exists suspicion of complicating factors or risk of malignancy. In nontoxic MNG, suppression therapy or serial clinical exams and TSH values are appropriate in an asymptomatic, nonsuspicious goiter. In toxic MNG, treatment of the resulting thyrotoxicosis followed by RAI or surgery is indicated. When compressive symptoms, risk of malignancy, or cosmetic deformity develops, surgery also may be indicated.