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

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' disease, thyroiditis and toxic adenoma.

### **6. Treatment**

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 per day in non-pregnant adults.

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

In multinodular goiter and toxic adenoma treatment modality is either radioiodine ablation surgery.

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 postmenopausal women not on HRT.

Surgery is indicated in patients with large goiters with compressive symptoms, malignancy, and failed medical therapy.

#### **7. Conclusions**

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 according to the etiology.

**11**

**Author details**

Sciences - BHU, India

Dhananjaya Melkunte Shanthaiah1

, Piyush Gupta<sup>2</sup>

2 Department of General Surgery, University of Massachusetts, Worcester, USA

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

1 Department of Endocrinology and Metabolism, Institute of Medical

\*Address all correspondence to: drnkavns@gmail.com

provided the original work is properly cited.

and Neeraj Kumar Agrawal1

\*

*Goiter: Overview of Aetiopathogenesis and Therapy DOI: http://dx.doi.org/10.5772/intechopen.90028*

The authors declare no conflict of interest.

**Conflict of interest**

*Goiter: Overview of Aetiopathogenesis and Therapy DOI: http://dx.doi.org/10.5772/intechopen.90028*
