| | Advantages | Disadvantages |
| Surgery[1] | - Goiter is either completely or largely excised
- Symptoms from tracheal or esophageal compression are rapidly relieved
- A definite histologic diagnosis is obtained
| - Expensive due to inpatient or ambulatory surgical center setting
- Injury to recurrent laryngeal nerve or all 4 parathyroid glands (1 to 2%)
- Risk of hypothyroidism dependent upon the extent of surgical resection
- Risk of regrowth of goitrous tissue if remnant tissue remains postoperatively
|
| Radioiodine[1,2] | - Usually administered in outpatient setting, relatively lower cost
- 1 year goiter reduction of 50% with improved pulmonary function
- Retreatment possible
- Avoidance of surgical scars
| - Radioiodine uptake may be insufficient to allow successful treatment
- Radiation precautions of 1 week or more are necessary based on local radiation safety regulations
- Goiter reduction may take months and may be ineffective for large glands or large obstructive nonfunctional nodules
- May need more than 1 dose
- Small risk of thyroiditis with acute swelling of the goiter
- Transition to Graves' disease in up to 5% of patients
- Variable risk of hypothyroidism, 15 to 20% after the first year, dependent upon extent of autonomy and TSH level at the time of treatment
- After radioiodine treatment, pregnancy should be avoided for 6 months
- Long-term cancer risk unknown
- Continued long-term monitoring with thyroid ultrasound
- Goitrous tissues treated with radioiodine acquire falsely suspicious ultrasonographic characteristics and also falsely suspicious FNA cytology findings, which may require surgery for reassurance
|
| Thermal ablation techniques[3] | - Outpatient
- Reduction in nodule volume (60 to 80%)
- Improvement in compressive symptoms and cosmetic concerns
- Avoidance of surgical scars
- Avoidance of thyroid hormone replacement
| - Painful if not performed with sedation
- Risk of thermal injury (recurrent laryngeal nerve or other structures)
- Risk of periprocedural bleeding requiring conversion to open surgery
- Need for multiple sessions
- Delayed diagnosis of missed malignancies
- Regrowth of treated nodules
- Continued long-term monitoring with thyroid ultrasound
|
