Treatment of Toxic Nodular Goiter
Antithyroid drugs can be used as first line in a sick patient with severe hyperthyroidism, and in some with subclinical hyperthyroidism. No remission is possible like Graves’.ATDs are temporary to eventual definitive therapy by surgery or Radioiodine. However4 in very sick patients with other diseases ATDs can be used.
Surgery must remove all the autonomous tissue.Single toxic can be treated by lobectomy, and multiple toxic nodules by near total thyroidiectomy. A high volume (>25/year)surgeon should do all near totals.
Radioiodine is the method of choice for elderly toxic nodule patients if there are no risk for associated cancers in a large gland.