Management of toxic nodular goitre

Adults with toxic nodular goitre

Offer radioactive iodine as first-line definitive treatment for adults with hyperthyroidism secondary to multiple nodules unless it is unsuitable (for example, there are concerns about compression, thyroid malignancy is suspected, they are pregnant or trying to become pregnant or father a child within the next 4 to 6 months, or they have active thyroid eye disease).

Offer total thyroidectomy or life-long anti-thyroid drugs as first-line definitive treatment for adults with hyperthyroidism secondary to multiple nodules if radioactive iodine is unsuitable.

Offer radioactive iodine (if suitable) or surgery (hemithyroidectomy) as firstline definitive treatment for adults with hyperthyroidism secondary to a single nodule, or life-long anti-thyroid drugs if these options are unsuitable.

Children and young people with Graves' disease or toxic nodular goitre

Offer anti-thyroid drugs, for at least 2 years and possibly longer as first-line definitive treatment for children and young people with Graves' disease.

Consider continuing or restarting anti-thyroid drugs or discussing radioactive iodine or surgery (total thyroidectomy) for children and young people with Graves' disease who have had a course of anti-thyroid drugs but have relapsed hyperthyroidism.

For children and young people with hyperthyroidism secondary to a single or multiple nodules:

• offer anti-thyroid drugs using a titration regimen of carbimazole, and
• discuss the role of surgery and radioactive iodine with the child, young person and family, following input from the multidisciplinary team.

Reference:

1. NICE. Thyroid disease: assessment and management. NICE guideline NG145. Published November 2019, last updated October 2023.