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Med Clin North Am. 2012 Mar;96(2):351-68. doi: 10.1016/j.mcna.2012.01.010.

Approach to and treatment of goiters.

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Division of Endocrinology, Department of Medicine, University of Sao Paulo Medical School, Rua Artur Ramos, 96 - 5A, 01454-903 Sao Paulo, Brazil.


The main causes of simple diffuse goiter (SDG) and multinodular goiter (MNG) are iodine deficiency, increase in serum thyroid-stimulating hormone (TSH) level, natural goitrogens, smoking, chronic malnutrition, and lack of selenium, iron, and zinc. Increasing evidence suggests that heredity is equally important. Treatment of SDG and MNG still focuses on L-thyroxine-suppressive therapy surgery. Radioiodine alone or preceded by recombinant human TSH stimulation is widely used in Europe and other countries. Each of these therapeutic options has advantages and disadvantages, with acute and long-term side effects.

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