Many lakes worldwide are experiencing great change due to eutrophication. Consequently, species composition changes, toxic algal blooms proliferate, and drinking water supplies dwindle. The transition to the deteriorated state can be catastrophic with an abrupt change from macrophyte to phytoplankton domination. This has been shown repeatedly in small lakes. Whether such alternative stable states also exist in large shallow lakes is less clear, however. Here we discuss the characteristics that give rise to alternative stable states in large shallow lakes either in the lake as whole or restricted to specific regions of the lake. We include the effect of lake size, spatial heterogeneity and internal connectivity on a lake's response along the eutrophication axis. As a case study, we outline the eutrophication history of Lake Taihu (China) and illustrate how lake size, spatial heterogeneity and internal connectivity can explain the observed spatial presence of different states. We discuss whether these states can be alternatively stable by comparing the data with model output (PCLake). These findings are generalised for other large, shallow lakes. We conclude that locations with prevailing size effects generally lack macrophytes; and, therefore, alternative stable states are unlikely to occur there. However, most large shallow lakes have macrophytes whose presence remains unexplained when only size effect is taken into account. By including spatial heterogeneity in the analysis, the presence of macrophytes and alternative stable states in large shallow lakes is better understood. Finally, internal connectivity is important because a high internal connectivity reduces the stability of alternative states.