Tanvir Ahmad, Badar-ud Duja, Nazim Hayat, Rehan A G.
Clinical Presentation of patients with Multinodular Goiter at Madina Teaching Hospital.
Annals Punjab Med Coll Jun ;7(2):108-13.

Objectives: To evaluate the different modes of clinical presentation of multinodular goiter, its association with environmental risk factors and outcome of subtotal thyroidectomy in these patients.  Methods: It was a case series conducted at Madina Teaching Hospital from January 2012 to Dec 2012. All patients presenting in surgical department with multinodular goiter were included in study. Data was analyzed by SPSS version 19. Results: Out of 100 patients presenting with multinodular goiter, 59% were in the euthyroid state, 39 % had thyrotoxicosis while only 2 of these had hypothyroidism. Goiter was more common in females (79 %) and between 31 to 40 years of age. Maximum number of patients was from Chiniot (46%). Majority (53%) patients presented with history longer than 5 years. The thyroid function status was not significantly associated with duration of swelling (p = 0.290)Age of the patient was significantly associated with their clinical presentation (p 0.013). Among the 39 26(66%) patients belonged to endemic areas and 12 (33%) patients had history of iodine intake while 15 (38%) patients had family history of Goiter. Most common post operative complication was hematoma formation (6%). Conclusion: The increasing evidence of thyrotoxicosis among multinodular goiter patients might be associated with increased intake of iodine in endemic areas for goiter prophylaxis, family history of thyrotoxicosis and delayed presentation. This area needs further research to explore other underlying factors for this changed clinical presentation in different parts of the world. Furthermore, subtotal thyroidectomy is safe surgical option in benign multinodular goiters with low morbidity. 

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