What is the best possible treatment for multinodular toxic goitre?

Question

Hi doctor,

I have a 2 inch cold nodule, multinodular toxic goiter, which is not cancerous. However, it has been suggested to have a complete thyroidectomy because the cold nodule will not take up radioactive iodine treatment. I am somewhat nervous about having my entire thyroid removed. What is your opinion regarding the use of radioactive iodine? Do you agree that it is the inferior option to a thyroidectomy because the radioactive iodine is not able to destroy the cold nodule? Also the concern to me is that both a thyroidectomy and radioactive iodine treatment seem to carry associated risks. Which of the two options carries the lower risk of complications? If radioactive iodine treatment is the lower risk yet still does not erase the cold nodule, will a thyroidectomy be the best route?

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I would strongly advise going for a complete thyroidectomy instead of a radioactive one. As you already know, radioactive iodine will not be taken up by different nodules evenly due to different activities. It will create a mess, partially destroying the thyroid, and the residual thyroid will be nonfunction, mostly in cold nodules. The best option is to start on full thyroid replacement. It is just one pill per day, and you will ultimately need up to 200 mg daily to keep TSH levels (thyroid stimulating hormone) normal.