{
  "schema_version": 1,
  "kind": "condition",
  "id": "simple-goitre",
  "name": "Simple (Euthyroid) Goitre",
  "category": "chronic",
  "sources": "NICE CKS: Thyroid disease 2023 · 2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management (PMC10448590)",
  "review_status": "reviewed",
  "verified_against": "2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management (PMC10448590)",
  "verified_date": "2026-08",
  "treatments": [
    {
      "id": 1642,
      "generic": "Clinical Monitoring & Watchful Waiting (Primary Care)",
      "line": 1,
      "is_adjunct": false,
      "form": null,
      "strength_mg": null,
      "adult_dose": "Confirm euthyroid with TSH and free T4, and get a baseline ultrasound. Then scan by risk, not by calendar: a benign or low-risk nodule (EU-TIRADS 2-3) under 10 mm needs no further imaging at all, and over 10 mm is re-evaluated in 3-5 years. Intermediate risk (EU-TIRADS 4) is re-evaluated within 1 year, high risk (EU-TIRADS 5) every 6-12 months. No drug treatment is needed for an asymptomatic euthyroid goitre",
      "adult_duration": "lifelong, at an interval set by the ultrasound risk category",
      "dose_source": "2023 European Thyroid Association Clinical Practice Guidelines for thyroid nodule management (PMC10448590)",
      "rationale": "Most simple euthyroid goitres are benign, asymptomatic, and remain stable without active drug treatment; routine TSH suppression with levothyroxine is discouraged due to long-term cardiac and bone risks.",
      "cautions": [
        "A blanket 12-24 month scan is wrong in both directions - it over-scans a benign nodule that needs nothing for 3-5 years, and under-scans a high-risk one that needs 6-12 months.",
        "Screen for compressive symptoms (dysphagia, dyspnea, hoarseness, stridor) which require urgent ENT and endocrinology referral for surgical evaluation.",
        "Perform baseline thyroid ultrasound to evaluate gland volume and rule out suspicious nodules requiring fine-needle aspiration biopsy (FNAB).",
        "Re-check serum TSH annually or if clinical symptoms of thyroid dysfunction develop.",
        "Do not give levothyroxine to shrink it. The guideline is explicit: thyroid hormone treatment is not indicated in euthyroid people with nodular thyroid disease. It does not reliably shrink the nodule, and suppressing TSH carries its own morbidity and mortality."
      ],
      "peds_mgkg_low": null,
      "peds_mgkg_high": null,
      "peds_max_mg": null,
      "peds_basis": null,
      "peds_unit": null,
      "peds_note": "Pediatric goitre requires pediatric endocrinology evaluation to rule out juvenile autoimmune thyroiditis or iodine deficiency.",
      "peds_min_weight_kg": null,
      "peds_max_weight_kg": null,
      "peds_age_min_months": null,
      "peds_age_max_months": null,
      "peds_age_bands": null,
      "peds_doses": null,
      "brands": [],
      "condition_id": "simple-goitre"
    }
  ]
}