| In general, the risk of malignancy is not increased in patients with multinodular goitre, but in the few cases where malignancy is suspected (e.g. prominent firm to hard cold nodule with nondiagnostic or neoplastic cells by fine needle aspiration, rapidly growing nodule, a vocal cord paralysis, suspicious lymph nodes in the neck, past neck irradiation) surgery is the option. In the vast majority of patients where malignancy is not suspected assesment of thyroid function is important for choice of treatment. A high normal or elevated serum TSH suggest an autoimmune component of the goitre, and that TSH stimulation is involved in goitrogenesis. T4 substitution therapy to achieve low normal serum TSH is recommended. Reference ranges for serum TSH normally include subjects with borderline subclinical autoimmune thyroiditis and serum TSH tends to decrease in multinodular goitre. Hence, serum TSH above 2 mU/l (depending on assay) is high for a patient with goitre. |
