THE CONTEXT
Management depends on the stage of simple goitre, symptoms, concern for malignancy and the individual balance of surgical risks and benefits.
Prevention and early treatment
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Introducing iodised salt has strikingly reduced the incidence of goitre in endemic areas.
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An early hyperplastic goitre may regress with thyroxine at 0.15–0.2 mg daily for a few months.
Natural history and need for surgery
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The nodular stage of simple goitre is irreversible, but more than half of benign nodules regress in size over 10 years.
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Most patients with multinodular goitre are asymptomatic and do not require an operation.
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Surgery is indicated for features of underlying malignancy, pressure symptoms after other causes have been excluded, or cosmetic concerns when the patient finds the goitre unsightly.
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Surgery should be considered when the goitre causes tracheal compression.
Individual surgical assessment
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Some goitres causing tracheal compression are detected incidentally in asymptomatic, often very elderly patients.
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Because these goitres often grow very slowly, surgical risks and benefits require careful consideration, particularly when a sternal split may be needed for access.