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Is surgery necessary for removing toxic multinodular goiter (MNG)?

Q: I am a 36 years old female suffering from hyperthyroidism. I had a c-section two years back after which I had colon infection. My T3 is 4.59 ng/ml, T4 - 28.41, TSH - 0.01. The thyroid scan has revealed the presence of toxic nodular goiter (TNG) of size 7-8 mm in right the thyroid gland. The FNAC indicates a colloid goitre. My doctor has prescribed me Carbimazole 5mg (2-2-2); Propranolol hydrochloride (1-0-1) to bring down my T4 level to normal after which the toxic MNG will be removed surgically. I want to know the further course of action. What are the complications involved me my case? Is surgery necessary for removing Toxic MNG?

A:Options for treatment of Toxic MNG are medications (you are already taking), surgery or radioiodine therapy. I suggest you to go for radioiodine therapy. As your gland seems to be not very large, surgery can be avoided easily. Other options are fine. Radioiodine therapy is very good option except that you have to wait for some time as you have a small baby and you might be lactating. By this therapy thyroid gland is destroyed by radioiodine. This modality is more suited for patients with toxic nodule or toxic MNG. Till you go for this therapy continue with the medications prescribed by your doctor.

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