Often the patient has had a chronic goitre for many years:
Multinodular goitre (MNG) is the most common thyroid disease in the world, with more than 300 million people estimated to be affected (1)
Progression to multinodular goitre is typical of both endemic and sporadic simple goitres. The nodules can be considered as the end result of patchy and disorganised thyroid metabolism in which some areas of hyperplasia progress to hyperplastic nodules. Some nodules undergo colloid involution while others develop haemorrhage, form cysts or undergo necrosis. Fibrosis and calcification occur in some of these degenerate nodules.
The goitrous enlargement may be huge; in some cases attaining a weight of over 2 Kg. The gross pattern is unpredictable. One lobe may be predominantly involved causing lateral pressure on midline structures such as the trachea and oesophagous. In others, the enlargement is mainly retrosternal producing an intra-thoracic or plunging goitre. The great veins may be compressed.
Common pitfalls during examination are to mistake a multinodular goitre for a large nodule because the goitre is dominated by one nodule. Failure to recognise retrosternal extension may be avoided by examining the lump with the neck extended.
Occassionally, a multinodular goitre is toxic. However, the ophthalmic and systemic changes typical of Grave's disease are absent
Malignant change has been stated to occur in 5-10% of untreated multinodular goitres (2)
Multinodular goitre must be differentiated from anaplastic thyroid carcinoma and thyroid lymphoma.
Last edited 12/2019