How is multinodular goiter diagnosed?

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If a multinodular goiter is found or suspected, a thorough history and physical exam should be performed. Important history includes how fast the thyroid is growing, risk factors for thyroid cancer (i.e. family history of cancer and history of radiation therapy to the neck or chest), family history of goiter, hoarseness, and symptoms of hyperthyroidism. Important physical exam findings include a goiter that can be felt, growth down into the chest, and enlarged neck veins.

After a complete history and physical exam, a thyroid ultrasound (USG) should be done. There is no radiation associated with an USG. An USG is the best test to look at the thyroid and will allow the doctor to see the size of the thyroid and specific features of the nodule(s) including: size, number of nodules, if there are calcifications (calcium deposits), echotexture (i.e. how bright or dark it looks on USG), borders, shape, and if it is solid or cystic (i.e. fluid-filled).

The best test to determine if a thyroid nodule is benign or cancer is a fine-needle aspiration biopsy (FNAB). In this test, a small needle (like the needles used for drawing blood) is placed into the nodule either by USG or feeling the nodule with the fingers. Cells are removed from the nodule into the needle (i.e. aspirated) and looked at under the microscope by a specially trained doctor called a cytologist. There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. If a patient has risk factors for thyroid cancer (especially a family history of thyroid cancer or exposure to radiation therapy) or suspicious findings on USG, then nodules over 0.5 cm should be biopsied. 

Your doctor may be able to diagnose a goiter simply by feeling your neck during a physical examination, and in the case of a multinodular goiter, may be able to feel the separate nodules on your thyroid. Several more tests can confirm a goiter. Blood tests can measure the level of thyroid hormones in your blood to test whether your thyroid is overactive or underactive. An ultrasound or thyroid scan can allow your doctor to see an image of your thyroid, and antibody tests can confirm whether an autoimmune disorder is causing your goiter.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.