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● Euthyreotic goiter results predominantly from endemic iodide defficiency.
● Diffuse goiter is treated for 12-18 months with potassium iodide in children and in combination with levothryoxine in adults. Treatment is adjusted to maintain low-normal TSH level (0.3-1.2 µIU/ml) and it is followed by life-long secondary prophylaxis with potassium iodide.
● Pharmacotherapy is less effective in nodular goiter due to fibrotic remodelling of the gland and it is contraindicated in the presence of autonomous ("hot") nodules. Thyreidectomy is best for rapid relief of mechanical symptoms and obligatory in the presence of malignant nodules. Radioiodine works better in patients without fibrotic remodelling and it is preferred in multimorbid elderly patients. It is contraindicated in the presence of malignant nodules, in children, and during pregnancy. Either therapy may result in treatment-obligatory hypothyroidism. Post-treatment thyroid function should be monitored annually.
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