Management of benign nodular goiter in euthyroid adults

CT: computed tomography.

* Where expertise is available, thermal ablation techniques (eg, radiofrequency ablation, microwave ablation) may be an option to reduce nodule size. There are limited data in patients with obstructive or substernal goiters, and these techniques should be applied with caution in such patients.

¶ For patients who choose continued surveillance, monitor annually for thyroid function test abnormalities and evidence of growth. Ideally, definitive treatment should be pursued before development of symptoms or patient comorbidities that may preclude surgery. For patients with minimally substernal goiters, the goal is to treat before goiter extends into the chest.

Δ For nonsubsternal goiter: Imaging with thyroid ultrasound initially annually and then at increasing intervals (eg, 2 to 5 years) if stable. For substernal goiter: Imaging with CT initially after 1 year and then less frequently if goiter is stable.