Management modalities:
(1) annual monitoring
(2) surgical resection
(3) treatment with radioactive iodine
Indications for definitive management:
(1) evidence of hyperthyroidism
(2) compression syndrome
(3) cosmesis
(4) concern about malignancy
Annual monitoring (with TSH levels) is indicated if:
(1) the goiter is small or modest in size
(2) the patient is euthyroid with normal TSH
(3) clinically asymptomatic without signs of compression syndrome
(4) fine needle aspiration (FNA) cytology of all suspicious nodules is benign
Radioactive iodine may be given if:
(1) the patient is unable or unwilling to undergo surgery
(2) the symptoms are not serious enough to require immediate relief
For all other situations surgical resection is the treatment of choice.
