<prompt> 30 year old female presents to OPD with complaints of palpitations, increased appetite but with significant weight loss.She also gives history of large neck swelling for which she has never been tested before . Her thyroid function tests showed raised T3,T4 and supressed TSH . Her TSH receptor antibody test was negative . On USG neck , multiple nodules were seen in the gland . Increased Radioactive Iodine Uptake RAIU . After achieving her euthyroid state , what shall be the best definitive step in management ?Continue antithyroid medicationSub-total thyroidectomyRadioactive iodineNear- total thyroidectomy  <response>: Toxic Multinodular goiter CF- Palpitations Weight loss Increased appetite. Ix - T3 ,T4 , TSH Negative TSH-R ab. USG - Multiple nodules Isotope scan- Several areas of increased uptake. Rx After achieving euthyroid state , Near total thyroidectomy is preferred Near total Thyroidectomy- Leaving 1 gram of thyroid tissue adjacent to recurrent laryngeal nerve at ligament of berry. Only in elderly ,subtotal thyroidectomy is done. 