Nonsurgical treatment of multinodular nontoxic goitre.

Sporadic multinodular goitre is common in the UK, affecting up to 40,, of the population. Spontaneous reduction in goitre size is unlikely and steady growth at about 20",, per annum may be seen if untreated. Treatment is indicated for pressure symptoms on the trachea, assymmetrical increase in size suggesting underlying malignancy, a sudden increase in size due to colloid degeneration or haemorrhage, for cosmetic reasons, or to treat patient anxiety. Traditionally, surgery has been the mainstay of treatment and has usually been a bilateral subtotal thyroid lobectomy leaving approximately 4 g of tissue on either side. Although the procedure rapidly relieves pressure symptoms, the goitre recurs in 10150 of patients, the exact number depending on definition and length of follow-up but independent of whether thyroxine is given after operation. Many surgeons would employ a total lobectomy on one side and subtotal thyroidectomy on the other to make re-operative surgery safer, but the latter situation increases the possibility of complications (recurrent laryngeal palsy, hypothyroidism, and hypocalcaemia). Complications are commoner with increasing gland size, patient age and comorbidity. Additionally, some patients do not wish to undergo surgery.