Evaluation and treatment of sporadic nontoxic goiter--some answers and more questions.

Sporadic nontoxic goiter (SNG) is defined as a benign enlargement of the thyroid gland in a euthyroid subject living in an iodine-sufficient area. Such goiters can be diffuse, uninodular, or multinodular and can vary greatly in size at presentation, growth rate, and symptomatology. The causes of SNG are incompletely understood, but include autoimmune, genetic, and extrinsic factors. SNG is a common entity in clinical practice, because patients often present with a small, diffuse goiter or a solitary palpable nodule. In addition, recent studies using high resolution ultrasound report that ;50% of people with a solitary palpable nodule or a diffusely enlarged gland actually have multiple nodules (1– 4). In addition, up to 50% of the general population have thyroid nodules by ultrasound, even when the gland is normal to palpation. Although SNG is common, there are a number of unresolved issues regarding its natural history, recommended evaluation, and optimal treatment that will be summarized here.