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Not necessarily, but...
I had a goiter for several years (2004) before it's removal in 2009. It was a watch and see approach. After the initial fine needle biopsy to rule out cancer, I was told well it is so large you can't biopsy everything. Great. It came back benign. So, I didn't have surgery back then. I took levoxyl for hypothyroidism and to keep goiter down. It wouldn't stay down and I noticed it got larger in 2008 (another biopsy) which again showed benign multinodular goiter. It was playing around with right side growing/left side growing so a fine needle biopsy did not help then since it came back benign.
Finally, a corotid (sp) ultrasound by Primary doc because of dizziness, showed goiter enlarged. Went back to endo, got a surgery referral, had TT in July 09 and found papillary carcinoma T2.
In my case, I did not have breathing difficulty or swallowing issues which is really bizarre. In those cases it is clear to have it removed if the size of it is an issue. With meds, if it doesn't remain the same or shrink, then it is time to look at why. A friend of mine's goiter went down with medication. Mine obviously didn't. People live with goiter all the time, just be aware if it continues to enlarge that there is a problem.