Multiple bilobar thyroid nodules are most commonly associated with nodular goiter, a compensatory hyperplasia of the thyroid follicles, most often in middle-aged women, but also in adolescent and pregnant women, mainly due to imbalances in thyroxine metabolism.
In addition, it may also present with geographic variations, or what is often called “big neck disease,” which is a diffuse goiter caused by a lack of iodine in the diet of certain regions. In some cases, it can extend into the posterior sternum, forming a retrosternal goiter, causing discomfort such as chest tightness, breath-holding, and palpitations after activity.
Some other patients will have secondary hyperthyroidism or hypothyroidism, requiring further refinement of thyroid function testing.
In addition, there is a risk of malignancy in bilobar thyroid nodules, which can be determined by a combination of other ultrasound signs including nodule morphology, border, calcification, blood flow, and aspect ratio, and in cases where malignancy is highly suspected, further puncture biopsy is required. The first thing you need to do is to take a look at the nodules and see if they’re serious.