Patients with multi-nodular toxic goitres are typically older than those with Graves' disease and are more likely to have co-existing cardio-pulmonary, hypertensive and other co-morbid disease.
Multi-nodular goitres are usually benign but rapid enlargement, lymphadenopathy or hoarseness should signal the possibility of a concurrent malignancy. Suspicious areas, usually enlarging cold nodules, are best biopsied by fine needle aspiration prior to RAI treatment.
It is less likely than in the case of Graves' disease that patients with multi-nodular toxic goitres will be rendered hypothyroid by a single treatment. The least abnormal tissues are likely to be suppressed by hormone output from the more autonomous nodules and the survivors will resume function after the currently toxic nodules have been destroyed. The delivered radiation dose from any one treatment will vary
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