Treatment options other than drugs

Thyroid drugs are not the treatment of choice for all thyroid conditions, nor are they always sufficient in cases where they are prescribed. For example, not all patients with hyperthyroidism respond well to anti-thyroid drugs, or can achieve remission. Treatment with radioactive iodine (RAI) or surgery may (eventually) offer a better solution to those patients.

Thyroid cancer requires surgical removal of the entire or part of the thyroid gland. In some cases, particularly when the cancer has spread, patients also need treatment with radioactive iodine.

Surgery is usually recommended for patients with a large goitre or large nodules that make breathing or swallowing difficult. Thyroid nodules diagnosed as indeterminate or suspicious by a biopsy are usually also surgically removed. Nodules producing too much thyroid hormone may either be removed surgically or treated with RAI or radiofrequency ablation.

Radiofrequency ablation (RFA) is a minimally invasive, non-surgical procedure that can be used to treat certain benign thyroid nodules. It can be an alternative treatment for patients who are not suitable for thyroid surgery (for example, older patients or patients with comorbidities) or who do not wish to have surgery (for example, to avoid the risk of complications or developing hypothyroidism). In New Zealand, RFA is performed by interventional radiologists or endocrine/ENT surgeons.

Small, noncancerous nodules that aren't growing and don't cause any symptoms are often not treated, but monitored by means of physical exams, thyroid function tests and sometimes ultrasound.