The clinical and laboratory evaluation described and outlined in the Figure for individuals with clinical solitary thyroid nodules is relevant to individuals with a multinodular goiter. The management strategy may differ from individuals with single nodules in the following ways: (1) Thyrotropin-suppressive doses of levothyroxine to treat elderly persons may cause iatrogenic thyrotoxicosis due to areas of autonomy within the goiter and should generally be avoided. (2) Multinodular goiters are more likely than single nodules to result in cosmetic concerns or, if very large, result in pressure symptoms. In such individuals, surgery may be appropriate. (3) Radioactive iodine (ie, iodine 131) has been used successfully to reduce goiter size in selected individuals with a multinodular goiter, in whom surgery is unnecessarily risky or contraindicated.[6] The dose of iodine 131 that is required in such patients is significantly greater than that used for patients with either Graves hyperthyroidism or a toxic nodular goiter.