Simple goiters without symptoms of hypothyroidism, inflammation or compression may be left untreated. It should be treated accordingly in the following cases: 1. local compression causing severe discomfort: if the patient has difficulty in breathing due to compression of the airway, minimally invasive surgery may be performed; 2. oversized goiter: surgery or radiation therapy may be performed; 3. rapid development of goiter in a short period of time: surgery may be performed; 4. development of Horner’s disease: surgery may be performed.