The natural history of benign goiter is usually slow growth of the nodules. Therefore, observation can be safe. If there is a suspicion of the nodules harboring cancer, the goiter is growing quickly, or if the goiter's large size is causing compressive symptoms, such as hoarseness, difficulty swallowing, or difficulty breathing, use of thyroid hormone to attempt to "suppress" and shrink MNG is not used because it puts patients at risk for hyperthyroidism.
Surgery for a goiter is used when a dominant nodule is suspicious for malignancy, the goiter is growing rapidly, or there are compressive symptoms due to the size of the goiter. The extent of surgery is based on the suspicion for malignancy, presence of thyroid dysfunction, and presence of bilateral nodules. In patients who have normal thyroid function, with compressive symptoms due to a single nodule, with a benign biopsy, and no nodules on the opposite side, unilateral thyroid lobectomy is appropriate. Otherwise, total thyroidectomy is the operation of choice.
Other non-surgical options may be available in the treatment of goiters. For non-surgical options, you should contact your endocrinologist.