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The treatment depends on the cause and size of the goitre:
If the goitre is a consequence of iodine deficiency in the diet, daily oral iodine supplements are recommended to prevent it from growing further, although it is difficult to decrease its size once it has become established.
If the goitre is due to Hashimoto's thyroiditis and hypothyroidism, treatment with thyroid hormones is prescribed and these should be taken daily to normalise thyroid function.
If the goitre is due to hyperthyroidism, the treatment depends on the cause. If the hyperthyroidism can be treated with radioactive iodine, as for example in Graves' disease, the goitre can be significantly reduced in size. The vast majority of goitres are multinodular and are associated with normal thyroid hormone levels.
Cases of asymptomatic goitre with normal thyroid function, with a benign appearance in an ultrasound and in a cytological examination, do not require specific treatment and clinical and ultrasound follow-up is recommended at a frequency that depends on the characteristics and size of the nodules. Even so, annual follow-up examinations are recommended because of the risk of developing hypothyroidism or hyperthyroidism in the future.
For large goitres and those that compress other cervical structures, causing symptoms similar to large nodules, surgical removal of the goitre, specifically total thyroidectomy, is recommended.
If the goitre is very large or if it is located in the thorax, the operation is more complex and may have side effects, although these are mostly transient, due to involvement of the nerve that controls the voice. After total removal of the thyroid, lifelong treatment with daily oral levothyroxine is required, which generally involves no complications and the patient has a normal quality of life.
Mireia Mora PortaEndocrinologistNutrition and Endocrinology Department
Published: 2 June 2021
Updated: 2 June 2021
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