**Conflict of interest**

*Goiter - Causes and Treatment*

*5.2.2.4 Fine-needle aspiration cytology*

*5.2.2.5 Computed tomography of neck*

disease, thyroiditis and toxic adenoma.

per day in non-pregnant adults.

dine ablation surgery.

**7. Conclusions**

according to the etiology.

menopausal women not on HRT.

malignancy, and failed medical therapy.

**6. Treatment**

indeterminate or suspicious features (ultrasound proven).

the extension of large cervical goiters and sub sternal goiters.

*5.2.2.6 Technetium-99 m (99mTc) thyroid scans/radioiodine uptake scans*

mandatory like palpable solitary nodule, palpable multinodular goiter, and suspicion of nodule in patient with difficult neck palpation, rapid growth of a goiter, thyroid asymmetry, firm consistency, tenderness, normal TSH and negative TPO antibodies.

Indications for FNAC include rapid growth of the swelling which suggest malignant transformation, signs of inflammation (abscess formation) and nodules with

Computed tomography of neck not usually advised is required rarely to assess

Routine use of thyroid scintigraphy is not indicated in the assessment of goiter. A hot area in scintigraphy suggest benign lesion which can be of help to rule out malignant lesions when FNAC report of the thyroid nodules are equivocal. When TSH level is low and clinical features are suggestive of hyperthyroidism technetium-99 scan/Radio iodine uptake scan are useful to differentiate between Graves'

Treatment of goiter depends on whether TSH levels are normal or abnormal. If TSH is elevated than normal, Levothyroxine supplementation is given for patient with overt hypothyroidism starting with a dose of 1.6 mcg/kg body weight

There are certain Indications for treatment of subclinical hypothyroidism like Anti-TPO positivity, menstrual irregularity, infertility, chronic kidney disease, pregnancy. If TSH is less than normal range then the treatment modality depends on the nature of the illness in Graves' disease we have got three effective treatment modalities, i.e., thionamides (anti-thyroid drugs), radioiodine or surgery. Starting dose of Methimazole ranges from 10 to 40 mg per day in divided doses initially followed by single daily dose-

In multinodular goiter and toxic adenoma treatment modality is either radioio-

Surgery is indicated in patients with large goiters with compressive symptoms,

The goiter is a known disorder affecting females more than males. It has various etiologies classified depending on the levels of TSH. The treatment of goiter is

Iodine radioisotope I-131 is usually used for radioiodine ablation. It takes 6–18 weeks for thyroid tissue ablation post radioiodine administration. Treatment of subclinical hyperthyroidism is considered in patient older than age of 65 years and patient with other comorbidities like heart disease, osteoporosis, and post-

Beta blockers are used for relief of tachycardia in non-asthmatic patients.

**10**

The authors declare no conflict of interest.
