Treatment

Treatment of euthyroid goitre is essentially aimed at reducing the size of the swelling to improve the cosmetic appearance and reduce pressure within the neck. It is mainly managed by effective replacement of the deficient dietary iodine. The effects of secondary compression from a very large goitre may need to be treated by surgical reduction of the size of the gland. Continued adequate intake of iodine in the diet should be ensured and any factors that may have interfered with iodine uptake should be managed.

Myxoedema is treated by replacement of the deficient thyroid hormone with oral thyroxine, which usually needs to be taken for life. The dose of thyroxine needs to be carefully adjusted to individual need by giving up to the full adult dose of 100-150 microgram’s per day.

Treatment of thyrotoxicosis is aimed at reducing the output of thyroid hormone and this can be achieved by using drugs, surgery to reduce the size of the gland or radioactive iodine compounds to destroy glandular tissue.

Antithyroid drugs such as carbimazole, methimazole or thiouracil compounds may be used. These are given orally and the dosage may need to be adjusted regularly to establish control. Treatment may need to continue for life but in some cases can be gradually withdrawn with continued monitoring of thyroid function.

Surgery consists of partial or near-complete removal of the thyroid gland (thyroidectomy) and in the best centres can achieve a cure in more than 98 per cent of patients. It is particularly useful where there is an associated large goitre but the procedure requires considerable skill as it has the potential to cause significant complications.

Treatment with radioactive iodine is gaining popularity. This is concentrated within the thyroid gland and destroys the cells that secrete thyroid hormone. It can give effective control of thyroid hormone output but has the risk of producing permanent hypothyroidism due to excessive destruction of thyroid tissue. Recurrent hyperthyroidism can occur following insufficient dosage of radio-iodine.

Management of other effects of thyrotoxicosis, particularly cardiac and ophthalmic complications, may also be needed. A ß-blockers such as propanolol (Inderal) may be used in initial stages to control symptoms such as rapid heartbeat and tremor.