What is the best approach to goiter in euthyroid patients?
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In the absence of outcome studies, experts recommend ultrasound evaluation of nontoxic multinodular goiters (MNG) followed by fine-needle aspiration (FNA) of suspicious nodules (strength of recommendation [SOR]: C, consensus-based guidelines). Thyroid hormone suppression therapyreduces the size of MNG (SOR: A, systematic review of randomized controlled trials [RCTs]), but it risks inducing hyperthyroidism (SOR: C, expert opinion). Experts recommend thyroidectomy for compressive symptoms, progressive growth, or ultrasound or FNA results indicating thyroid cancer (SOR: C, consensus based guidelines). Expert guidelines recommend repeat ultrasound at 6 to 18 months to follow up benign nodules or nonendemic MNG in patients at low risk of malignancy and subsequent follow-up of stable nodules every 3 to 5 years (SOR: C, consensus-based guidelines).
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