Purpose of review: To highlight recent advances in our understanding of the incidence of multinodular goitre (MNG) risk of malignancy, evaluation of patients with MNG, rates and factors predictive of malignancy in MNG, and the choice of surgical procedure for patients with neoplastic MNG.
Recent findings: The incidence of MNG when screened by ultrasound scanning (USS) is between 10 and 20% and when using high resolution USS can be up to 70%. The incidence of occult malignancy within MNG lies between 10 and 35% in surgical series. Younger patients and men have higher rates of malignancy, as do patients with a family history, prior irradiation and those with signs of compressive or invasive disease. Subtotal thyroidectomy has been rejected in favour of either total lobectomy or total thyroidectomy for most patients with MNG.
Summary: An increasing number of patients with MNG will be encountered in surgical practice. Most patients can be cured with total lobectomy or total thyroidectomy, which minimizes recurrence rates and ensures an oncological approach to patients with incidentally discovered malignancy within MNG.