Goiter: Drug Therapy

Therapy recommendations for:

  • Iodine-deficiency-related goiter and dyshormogenic goiter (enzyme defect in thyroid hormone synthesis).
  • Goiter with hypothyroidism (hypothyroidism).
  • Goiter with hyperthyroidism (hyperthyroidism)
  • Goiter during pregnancy and lactation

Iodine deficiency-related goiter and dyshormogenic goiter

Therapeutic target

  • Regression of iodine-deficiency-related goiter with improvement of symptoms.

Therapy recommendations

  • Iodine (150 μg/day), L-thyroxine or (the combination of iodide and L-thyroxine is increasingly discouraged because of the risk of inducing iatrogenic hyperthyroidism/hyperthyroidism caused by medical activity).
    • L-thyroxine: tablets to be taken in the morning on an empty stomach (at least 30 min before breakfast); if taken in the evening, it is recommended to take the tablets at least 2 hours away from the last meal (taking in the evening is the better option for absorption)
    • In the elderly, thyroid autonomy (independence of parts of the thyroid tissue from the thyrotropic control circuit) must be excluded before starting iodide therapy.
  • See also under “Further therapy“.

In case of insufficient response to monotherapy, a combination of the two agents is possible: L-thyroxine and potassium iodide (best evidence).

Further references

  • Struma therapy with drugs only leads to a reduction in thyroid volume of about 30-40%.
  • In the case of a struma nodosa, no long-term therapy with L-thyroxine (levothyroxine) should be performed.
  • Obsolete is the treatment of euythyroid nodular goiter with TSH suppressive therapy. Equally obsolete is monotherapy with L-thyroxine in diffuse goiter. Both lead to intrathyroidal iodine depletion and renewed thyroid growth after discontinuation of medication.

Radioiodine therapy

  • Efficient volume reduction in large and very large strumen (volumes 100-300 ml) by about 35-40% after one year, about 40-60% after two years.
  • Alternative to surgical struma therapy* , especially in speech occupations (lack of risk of (2.9%) transient or (0.7% ) permanent recurrent paresis) and in elderly patients
  • Long-term side effect: hypothyroidism requiring substitution (about 20-60% within 5-8 years after therapy); in rare cases, development of immunothyroidism (< 5%).
  • Lifelong follow-up because of possible hypothyroidism!

* In addition to the possible complication of recurrent paresis, there is a risk of permanent postoperative hypoparathyroidism (0.5-7%).

Goiter with hypothyroidism

Therapeutic Objective

Improvement of symptoms

Therapy recommendations

  • L-thyroxine
  • See also under “Further therapy”.

Goiter with hyperthyroidism

Therapy goal

Achieve a euthyroid metabolic state (= thyroid values in the normal range).

Therapy recommendations

  • Thyrostatic drugs (drugs that inhibit thyroid function and are used to treat hyperthyroidism)
  • Perchlorates; Indications: Prophylaxis before administration of contraceptives, therapy for amiodarone-induced thyroid dysfunction.
  • See also under “Other therapy.”

In pregnancy and lactation