[Treatment of endemic and sporadic goiter]

Early continuous hormonal treatment, inhibiting TSH secretion, reduces the volume of recent homogeneous goiters. This treatment is usually well tolerated, but can induce thyrotoxicosis in subjects with blunted response of TSH to TRH stimulation before treatment. Surgery is used for large goiters, compressive goiters or suspicion of cancer and after failure of the hormonal treatment. In all cases, hormonal treatment must be associated to surgery. Radio-iodine can be used for large or compressive goiters, when surgery is inadvisable. Despite the risk of thyrotoxicosis, iodine addition in food intake is useful to prevent goiters. The frequency of thyrotoxicosis can be decreased by ruling out subjects over 50 years old, with nodular goiters or with blunted response of TSH to TRH stimulation.