Many patients with pathological goiter can be treated with medications and isotopes to slow down the enlargement or even make the enlargement shrink gradually. There are some types of patients who are not suitable for surgery, such as those with enlargement caused by subacute thyroiditis, which is a self-limiting disease and can do more harm than good with surgery. Patients with Hashimoto’s thyroiditis who undergo surgery are at risk of accelerating the onset and progression of hypothyroidism and are not usually treated surgically. Surgery is necessary when an enlarged thyroid gland is found to have cancerous potential, or when the enlargement grows behind the sternum or presses on the trachea, which accounts for 10% to 20% of all patients with goiter.