A goiter may require no treatment, especially if it is small and thyroid hormone levels are normal. However, if your thyroid hormone levels are affected--either too high or too low-- you will need treatment.
Treatment involves getting the thyroid hormone levels back to normal, usually with medication. When the medication takes effect, the thyroid may begin to return to its normal size. However, a large nodular goiter with a lot of internal scar tissue will not shrink with treatment. If the goiter is uncomfortable, causes overproduction of thyroid hormone unresponsive to medications, is large enough that it causes symptoms because of its size, or becomes cancerous, the entire thyroid gland may have to be surgically removed.
Your doctor may want to reevaluate the goiter on a periodic basis with ultrasound to be sure that it is not growing larger or developing suspicious looking nodules that might require a fine-needle biopsy. .