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There is couple of aspects to it. One is the age of the patient, It is important as it decides as to what cycle the patient is in, in other words in many women whether she is in a reproductive age or in a non-reproductive age. These things can decide the hormonal interface or the hormonal orchestra of the body. So this also means when we talk about goiter we are talking about thyroid and thyroid is a part of the endocrine axis of the body, which deals with other organ systems, with hormones. So hormones have an interplay between them.it is not only the thyroid which is self-dependent. It depends on other factors. It can be other organ in the body which can play a primary role or a secondary role with a multinodular goiter and anti TPO antibody may not be the only marker, which will decide the treatment of the multinodular goiter. There are many other indications and biomarkers. There are many coexisting diseases. There can be an ultrasound needed or a biopsy needed to exactly come to a diagnosis. So anti TPO antibody in a multinodular goiter is only a part and parcel of a larger spectrum of disease which you have to find out. When it comes to women, we have to look at what all hormonal changes she is undergoing. Coming to the complications or any other disease. It can be coexisting diseases which can be there. It cannot be that there can be other diseases which can come as a complication, but it is important to understand the coexistence of other diseases and find out where it is coming from. multinodular goiter, can be precipitating factor or it can be the effect of something else.