Thyroid Nodules and Goiter

Many goiters and nodules can be followed with a "watch and wait" approach. If they are causing bothersome symptoms or impacting your health, however, they will need to be treated, often with surgery. This includes cases such as:

  • Large goiters that are uncomfortable or cause difficulty with breathing or swallowing.
  • Multinodular goiters, particularly those that constrict airways, the esophagus or blood vessels.
  • Nodular goiters causing hyperthyroidism (overactive thyroid), if treatment with radioactive iodine or anti-thyroid medications are not an option.
  • Goiters or nodules that are malignant (thyroid cancer).
  • Thyroid nodules that produce uncertain results on a biopsy.

Radioactive Iodine

This treatment is mainly used to shrink a goiter or nodule that causes the thyroid to produce too much thyroid hormone. The iodine is given as a capsule or liquid. Once swallowed, it concentrates in the thyroid and destroys some or all of the thyroid tissue, without harming other tissues.

Thyroid hormone medication (L-thyroxine)

This synthetic form of thyroid hormone can help to shrink an enlarged thyroid and treat an underactive thyroid. Hypothyroid symptoms usually start to improve within the first week of starting the medication, and disappear within a few months.


If a goiter has become so big that it's stretching or compressing nearby structures, or if it has become unsightly, you may need surgery to remove all or part of the thyroid. Similarly, large thyroid nodules – as well as nodules that your doctor suspects may be malignant – will likely need to be removed surgically.

Thyroid surgery carries a risk of affecting the voice, because of the potential for damage to the nerves controlling the muscles that move the vocal cords. This can range from losing a high octave or two while singing, to changing the voice to a whisper.

Depending on how much of the thyroid gland is removed, you may need to take synthetic thyroid hormone for the rest of your life.

UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.

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