A goiter may be large enough for you to see or to feel with your hand, or it may remain unnoticed until a doctor discovers it, perhaps during a routine exam.
In any case, the first step is to determine whether the goiter is a symptom of another thyroid condition. An ultrasound of the thyroid gland may help determine the size of the gland and the presence of nodules. Radioactive iodide uptake tests track how much iodide the thyroid takes in within a certain time period. Higher-than-normal amounts indicate possible hyperthyroidism; low levels indicate hypothyroidism. Blood tests can measure levels of thyroid hormone.
A goiter may require no treatment, especially if it is small and thyroid hormone levels are normal. However, if the goiter develops because of excessive thyroid hormone production, fails to produce enough hormone or causes discomfort, treatment is needed.
Treatment involves getting the thyroid hormone levels back to normal, usually with medication. When the medication takes effect, the thyroid may begin to return to its normal size. However, a large nodular goiter with a lot of internal scar tissue does not shrink with treatment. If the goiter is uncomfortable, causes overproduction of thyroid hormone unresponsive to medications, or becomes cancerous, the entire thyroid gland may have to be surgically removed.