In some cases, radioactive iodine can be used to treat an enlarged thyroid gland.  The iodine is taken orally and reaches the thyroid gland through your bloodstream, destroying thyroid cells. This treatment option is common in Europe, and its usage dates back to the 1990's. The treatment is effective in that 90% of patients have a 50 – 60% reduction in goiter size and volume after 12 to 18 months.  This treatment can result in an underactive thyroid gland, but such an issue is rare and usually shows up in the first two weeks after treatment. If you're concerned about the risk, talk this option over with your doctor beforehand. If you're diagnosed with hypothyroidism, that is an underactive thyroid, medications will be prescribed to treat the condition.  Thyroid hormone replacements, such as Synthroid and Levothroid, help with symptoms of hypothyroidism. This also slows the release of hormones from your pituitary gland, a compensatory response of your body, which may decrease goiter size. If your goiter does not decrease with hormone replacements, you will still stay on the medication to treat other symptoms. However, your doctor might suggest aspirin or a corticosteroid cream.  Thyroid replacement hormones are usually well tolerated in patients, but some side effects can occur. Side effects may include chest pain, increased heart rate, sweating, headaches, insomnia, diarrhea, nausea, and irregular menstrual cycles. The goiter can be removed surgically. A 3 to 4 inch (7.6 to 10 cm) cut will be made in the middle of your neck, on top of the thyroid gland, and all or part of the thyroid is removed. The surgery takes about four hours and most people go home the day of the surgery.  If your goiter is large enough to cause compression of the neck and esophagus, resulting in difficulty breathing and nighttime choking episodes, surgery is usually recommended. Although rare, a goiter can be caused by thyroid cancer. If malignancy is suspected, your doctor will likely want to remove the goiter surgically. A less common reason for surgery is cosmetic concerns. Sometimes, a large goiter is simply a cosmetic concern and patients may opt for surgery in this case. However, if it's a cosmetic concern insurance may not cover the cost of the operation. The same kind of hormone replacement therapy used for an underactive thyroid usually becomes necessary for life after the removal of the thyroid.
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