title: [Large goiter--diagnosis and treatment].
abstract: BACKGROUND
  The prevalence of large goiter is low in Norway compared with that for areas of iodine deficiency. Benign multinodular goiter is the most common cause. The most important differential diagnoses are cancer and autoimmune thyroid disease. Most multinodular goiters grow slowly and even large ones usually cause little discomfort.
  
  
  METHODS
  We present an overview of the most common causes, diagnostic procedures, complications and treatment of large goiters based on our own experience and selected literature.
  
  
  CONCLUSIONS
  The work-up aims at finding the cause and complications of goiter; i.e. hyperthyreosis, compression or cosmetic complaints. If cancer is considered, fine needle aspiration cytology, preferably ultrasound-guided, is the most important diagnostic tool. Imaging techniques do not differentiate precisely between benign and malignant lesions, but ultrasound is useful in guiding cytological sampling. Treatment of patients with multinodular goiter complications is influenced by general health, surgical risk and patient preferences. It is not necessary to treat all patients. The main treatments are thyroidectomy, partial resection and single or repeated radioiodine therapy. Pre-treatment with recombinant human thyroid stimulating hormone may increase the effect of radioiodine treatment and thereby expand the indication for non-surgical treatment.
authors.affiliation: Endokrinologisk seksjon, Medisinsk avdeling, Akershus universitetssykehus, 1478 Lørenskog. ansgar.heck@ahus.no
authors.forename: Ansgar
authors.initials: A
authors.lastname: Heck
authors.forename: Tone
authors.initials: T
authors.lastname: Cappelen
authors.forename: Ivar
authors.initials: I
authors.lastname: Følling
mesh_terms: D000368:Aged; D003937:Diagnosis, Differential; D005260:Female; D006042:Goiter / Q000150:complications / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006044:Goiter, Nodular / Q000175:diagnosis; D006801:Humans; D007037:Hypothyroidism / Q000175:diagnosis; D008297:Male; D012307:Risk Factors; D012737:Sex Factors; D013964:Thyroid Neoplasms / Q000175:diagnosis; D013967:Thyroiditis, Autoimmune / Q000175:diagnosis