Dr. Sheldon Rubenfeld Board Certified in Internal Medicine and in Endocrinology, Diabetes, and Metabolism

Treatment Options

The first and most important point to clarify about a goiter is if one or more thyroid nodules are present. If one or more thyroid nodules are present, then they may be evaluated for the possibility of cancer. If a patient has a goiter with no thyroid nodules, then physicians have little concern about cancer.

The size of the goiter as well as the age of the patient is also important when considering treatment. For example, a young patient with many years to live and a very large goiter may wish treatment simply because of the likelihood that the goiter will enlarge over the course of her lifetime. On the other hand, an older patient with a large goiter that is causing no symptoms may decide not to have any treatment, particularly if that treatment involves some risk (surgery, for example).

In a patient with a goiter and no thyroid nodule(s), thyroid function tests establish how the thyroid gland is fuctioning. If the patient is hypothyroid, then therapy with levothyroxine is begun. Levothyroxine will restore the patient to a euthyroid state and sometimes reduce the size of the goiter. If a patient is hyperthyroid, then the hyperthyroidism is treated, which usually results in a reduction in the size of the goiter.  

Most goiters and thyroid nodules are benign and are treated nonsurgically. Sometimes surgery is indicated for a goiter because of its large size or troublesome symptoms. A patient with a solitary thyroid nodule should not be overly concerned about thyroid cancer; less than 10% of solitary thyroid nodules are cancerous, and the overwhelming majority of patients with thyroid cancer are successfully treated.