Goitre due to nodular thyroid disease is common. Most patients present with benign disease and are euthyroid at presentation, but careful clinical evaluation (thyroid function tests and fine needle biopsy) is essential to determine appropriate therapy. Thyroid hormone therapy should be reserved for hypothyroid patients and those with Hashimoto's thyroiditis. Iodine supplements are not beneficial. Indications for surgery are a malignant or atypical finding on fine needle biopsy, a recurrent cyst larger than 4 cm in diameter, or a goitre causing obstruction.