From the Guidelines
Treatment for an enlarged thyroid (goiter) should be guided by the underlying cause and severity of symptoms, with a focus on minimizing morbidity, mortality, and improving quality of life. For mild cases without symptoms, watchful waiting with regular monitoring may be sufficient 1. When treatment is needed, the following options are considered:
- For hypothyroidism-related goiters, levothyroxine (typically starting at 25-50 mcg daily, gradually increasing as needed) is prescribed 1.
- For hyperthyroidism, options include methimazole (10-30 mg daily), radioactive iodine therapy, or beta-blockers like propranolol (10-40 mg three times daily) to manage symptoms 1.
- Surgical removal (thyroidectomy) may be necessary for large goiters causing breathing difficulties, suspicious nodules, or when other treatments fail 1.
- Iodine supplements (150-200 mcg daily) help if the enlargement is due to iodine deficiency 1. During treatment, patients should avoid goitrogenic foods like raw cruciferous vegetables in large amounts. Regular follow-up appointments are essential to monitor thyroid function and adjust medication dosages. Treatment effectiveness varies based on the cause, with most patients experiencing reduction in thyroid size and improvement in symptoms within weeks to months of starting appropriate therapy.
From the FDA Drug Label
Methimazole tablets, USP are indicated: In patients with Graves’ disease with hyperthyroidism or toxic multinodular goiter for whom surgery or radioactive iodine therapy is not an appropriate treatment option. The answer to enlarged thyroid treatment is methimazole (PO) for patients with Graves’ disease or toxic multinodular goiter as an alternative to surgery or radioactive iodine therapy 2.
- Key indications for methimazole include:
- Hyperthyroidism due to Graves’ disease
- Toxic multinodular goiter
- Methimazole is used to ameliorate symptoms of hyperthyroidism in preparation for thyroidectomy or radioactive iodine therapy.
From the Research
Enlarged Thyroid Treatment
- The treatment for an enlarged thyroid, also known as goitre, depends on the underlying cause and clinical presentation 3.
- Common causes of goitre include autoimmune disease, thyroid nodules, and iodine deficiency, which may lead to hyperthyroidism or hypothyroidism 3.
- Treatment options for goitre may include:
- Observation
- Iodine supplementation
- Thyroxine suppression
- Thionamide medication (carbimazole or propylthiouracil)
- Radioactive iodine ablation
- Surgery 3
- For hyperthyroidism caused by an enlarged thyroid, treatment options include antithyroid medications, radioactive iodine ablation, and surgical thyroidectomy 4, 5, 6.
- The choice of treatment depends on the underlying diagnosis, presence of contraindications, severity of hyperthyroidism, and patient preference 4, 5, 6.
Hyperthyroidism Treatment
- Hyperthyroidism can be treated with antithyroid medications (methimazole and propylthiouracil), radioactive iodine ablation of the thyroid gland, or surgical thyroidectomy 4.
- Radioactive iodine ablation is the most widely used treatment in the United States 4.
- Treatment for subclinical hyperthyroidism is recommended for patients at highest risk of osteoporosis and cardiovascular disease, such as those older than 65 years or with persistent serum thyrotropin level less than 0.1 mIU/L 5.
- First-line treatments for hyperthyroidism are antithyroid drugs, thyroid surgery, and radioactive iodine treatment, and treatment choices should be individualized and patient-centered 5.
Surgery and Radioactive Iodine Treatment
- Surgery is a treatment option for hyperthyroidism, particularly for those with a concurrent cancer, in pregnancy, for compressive symptoms, and in Graves' disease with ophthalmic manifestations 6.
- Radioactive iodine is a successful treatment for hyperthyroidism, but should not be used in Graves' disease with ophthalmic manifestations, and has an increased concern for the development of secondary cancers as a result of treatment 6.
- Patients who are not successfully treated with radioactive iodine can undergo re-treatment or surgery 6.