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In areas of iodine deficiency, goiter prevalence may be very high and especially in goiters of longstanding, multinodularity develops frequently (Figure 17-1).The incidence of multinodular goiter in areas with sufficient iodine intake has been documented in several reports (1-10).It became available online in 2010 and has been sold as replacement for 4-methylmethcathinone (mephedrone). As of 2011, it is most often found as a powder (either represented as 4-methylethcathinone or included in powder products that don't specify their active ingredients) and has appeared in some samples of "NRG-2", although it has also been found in tablet form.Some reports of 4-methylethcathinone use involve redosing ("boosting" or "bumping") multiple times.If the clinically euthyroid goiter is unsightly, shows subclinical hyperthyroidism or is causing pressure symptoms, treatment with ¹³¹I preceded by recombinant human TSH is successful but causes hypothyroidism in varying degrees.

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Nodules larger than 1 cm may be detected clinically by palpation.If a clinical and biochemically euthyroid MNG is small and produces no symptoms, treatment is controversial.