ABSTRACT
Aims of treatment in patient with nontoxic goiter are correction of thyroid dysfunction, if any, reduction size of the gland and prevention of further growth of goiter. The treatment decision for a benign goiter needs to be individualized.
Clinical observation is a modality of management in asymptomatic nontoxic goiter where the possibility of malignancy has been excluded by guided fine needle aspiration cytology. Individuals with large benign goiters with pressure symptoms or cosmetic concern require surgery. Total thyroidectomy should be considered for safe and effective operation to prevent goiter recurrence. Lobectomy should be the choice for symptomatic unilateral multinodular goiter. There is controversy regarding the effectiveness of LT4 and radioiodine (RAI) therapy in these patients, and it is better to avoid these forms of treatment unless there are compelling reasons. The decision between treatment and observation depends upon benefits and risk of medical or surgical therapy and other factors including patient's wishes, social factors, finances available, availability of experienced thyroid surgeon, belief of clinicians and local practice patterns.
