{"id":4422357,"date":"2025-01-11T14:53:48","date_gmt":"2025-01-11T20:53:48","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/goiters\/"},"modified":"2025-01-13T06:03:04","modified_gmt":"2025-01-13T12:03:04","slug":"goiters","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/goiters\/","title":{"rendered":"Goiters"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">EUTHYROID (NONTOXIC) GOITER<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Definition and Overview<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Euthyroid (Nontoxic) Goiter<\/strong>: Enlargement of the thyroid gland <strong>without<\/strong> clinical signs of hyperthyroidism or hypothyroidism.<\/li>\n\n\n\n<li>Common in areas with <strong>low dietary iodine<\/strong>, but also seen elsewhere.<\/li>\n\n\n\n<li>Early stage often <strong>diffuse<\/strong> enlargement; later can become <strong>nodular<\/strong> (multinodular).<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Clinical Presentation<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Age and Timing<\/strong>\n<ul class=\"wp-block-list\">\n<li>Often noted around <strong>puberty<\/strong> in both sexes when iodine intake is low.<\/li>\n\n\n\n<li>Gradual enlargement over many years, leading to various nodular patterns.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Goiter Characteristics<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Diffuse Goiter<\/strong> initially; later may develop nodularity (hard areas, cystic areas).<\/li>\n\n\n\n<li>May be <strong>symmetric<\/strong> or <strong>asymmetric<\/strong>; can extend <strong>intrathoracically<\/strong> (substernal goiter).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Obstructive Symptoms<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Tracheal Compression<\/strong> \u2192 dyspnea on exertion, stridor (in advanced cases).<\/li>\n\n\n\n<li><strong>Esophageal Compression<\/strong> \u2192 dysphagia.<\/li>\n\n\n\n<li><strong>Recurrent Laryngeal Nerve<\/strong> compression \u2192 vocal cord palsy.<\/li>\n\n\n\n<li><strong>Cervical Sympathetic Chain<\/strong> compression \u2192 <a href=\"https:\/\/myendoconsult.com\/learn\/horner-syndrome-mnemonic\/\" data-wpil-monitor-id=\"127\">Horner syndrome<\/a>.<\/li>\n\n\n\n<li><strong>Pemberton Maneuver<\/strong> (raising arms) can elicit <a href=\"https:\/\/myendoconsult.com\/learn\/facial-plethora\/\" data-wpil-monitor-id=\"128\">facial plethora<\/a>, cyanosis, or stridor if thoracic inlet obstruction is present.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Sudden Enlargement\/Pain<\/strong>\n<ul class=\"wp-block-list\">\n<li>May be due to <strong>hemorrhage<\/strong> into a nodule or cyst.<\/li>\n\n\n\n<li>Pain can radiate to ear, shoulder, or neck structures.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Possibility of Hyperfunction (\u201cHot Nodule\u201d)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Some nodules may become autonomously functioning \u2192 hyperthyroidism (toxic multinodular goiter).<\/li>\n\n\n\n<li><strong>Cancer<\/strong> is rare but possible within a multinodular goiter.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Evaluation and Diagnosis<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Exclude Hyperthyroidism<\/strong>\n<ul class=\"wp-block-list\">\n<li>Measure <strong>serum thyrotropin (TSH)<\/strong>.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/myendoconsult.com\/learn\/normal-thyroid-ultrasound-images\/\" data-wpil-monitor-id=\"124\">Thyroid Ultrasound<\/a><\/strong>\n<ul class=\"wp-block-list\">\n<li>Defines <strong>structure<\/strong> of nodules and extent of suprasternal goiter.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>CT\/MRI<\/strong>\n<ul class=\"wp-block-list\">\n<li>Useful for <strong>substernal<\/strong> (intrathoracic) extension.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Fine-Needle Aspiration Biopsy (FNA)<\/strong>\n<ul class=\"wp-block-list\">\n<li>If suspicious or prominent nodules are present to rule out malignancy.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h3 class=\"wp-block-heading\">Indications for Surgery<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Cosmetic Reasons<\/strong>\n<ul class=\"wp-block-list\">\n<li>Large, unsightly goiter size.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Sudden Enlargement<\/strong>\n<ul class=\"wp-block-list\">\n<li>Rapid growth or a suspiciously <strong>hard area<\/strong> suggesting neoplastic change.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Obstructive Symptoms<\/strong>\n<ul class=\"wp-block-list\">\n<li>Significant compression of <strong>trachea<\/strong> or <strong>esophagus<\/strong>, or thoracic inlet obstruction causing breathing\/swallowing difficulties. (<a href=\"https:\/\/myendoconsult.com\/learn\/pembertons-sign\/\" data-type=\"link\" data-id=\"https:\/\/myendoconsult.com\/learn\/pembertons-sign\/\">Review Pemberton Sign<\/a>)<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Malignancy<\/strong> suggested by Fine Needle Biopsy<\/li>\n<\/ol>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"1580\" height=\"905\" src=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome.jpg\" alt=\"\" class=\"wp-image-524800\" srcset=\"https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome.jpg 1580w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome-300x172.jpg 300w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome-768x440.jpg 768w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome-1536x880.jpg 1536w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome-624x357.jpg 624w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome-50x29.jpg 50w, https:\/\/myendoconsult.com\/learn\/wp-content\/uploads\/Horners-syndrome-100x57.jpg 100w\" sizes=\"auto, (max-width: 1580px) 100vw, 1580px\" \/><figcaption class=\"wp-element-caption\">Horner&#8217;s syndrome on account of significant thyromegaly<\/figcaption><\/figure>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">GROSS PATHOLOGY OF GOITER<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Types and Frequency<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Goiter<\/strong>: Enlargement of thyroid, often related to <strong>dietary iodine intake<\/strong>.<\/li>\n\n\n\n<li><strong>Nontoxic (Euthyroid) Goiters<\/strong>: Typically do <strong>not<\/strong> produce hypo- or hyperthyroidism, often appear during adolescence or pregnancy.<\/li>\n\n\n\n<li><strong>Early Diffuse<\/strong> \u2192 eventually can become <strong>multinodular<\/strong>.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Physical Examination and Growth<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Gland can be <strong>2\u20133\u00d7 normal size<\/strong> or larger; patients may notice neck fullness, tight collars, difficulty swallowing.<\/li>\n\n\n\n<li><strong>Compression<\/strong> of trachea \u2192 stridor; <strong>venous engorgement<\/strong> if thoracic inlet is narrowed.<\/li>\n\n\n\n<li>Gland feels firm (not hard). Over time, becomes <strong>asymmetric and nodular<\/strong>; nodules can differ in size and consistency.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Gross Appearance<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Large, <strong>nodular<\/strong> thyroid with possible <strong>hemorrhages, cysts, fibrosis, calcifications<\/strong>.<\/li>\n\n\n\n<li>Amber, translucent <strong>colloid<\/strong> on cut section.<\/li>\n\n\n\n<li>Some nodules are partially or fully encapsulated, mimicking <strong>follicular neoplasms<\/strong>.<\/li>\n\n\n\n<li>Rarely, <strong>cancer<\/strong> (e.g., <a href=\"https:\/\/myendoconsult.com\/learn\/histology-of-papillary-thyroid-carcinoma\/\" data-wpil-monitor-id=\"129\">papillary carcinoma<\/a>) arises within a multinodular goiter.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Cytology and Histology<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Fine-Needle Aspiration<\/strong> from colloid nodules usually shows:\n<ul class=\"wp-block-list\">\n<li>Abundant <strong>colloid<\/strong>, mixed cell populations (<a href=\"https:\/\/myendoconsult.com\/learn\/normal-thyroid-follicular-cells\/\" data-wpil-monitor-id=\"125\">follicular cells<\/a> with uniform nuclei, inflammatory cells, H\u00fcrthle cells).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Microscopy<\/strong> of multinodular goiter may show:\n<ul class=\"wp-block-list\">\n<li>Variable follicle size, some large (2 mm), coalescing into cystic areas.<\/li>\n\n\n\n<li>Rarely, malignant changes.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">ETIOLOGY OF NONTOXIC GOITER<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">General Mechanism<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Often due to <strong>partial deficiency<\/strong> in <a href=\"https:\/\/myendoconsult.com\/learn\/thyroid-hormone-synthesis\/\" data-wpil-monitor-id=\"126\">thyroid hormone synthesis<\/a> \u2192 <strong>increased TSH<\/strong> \u2192 thyroid hyperplasia\/enlargement.<\/li>\n\n\n\n<li><strong><a href=\"https:\/\/myendoconsult.com\/learn\/cretinism-an-iodine-deficiency-disorder\/\" data-wpil-monitor-id=\"130\">Iodine Deficiency<\/a><\/strong>: Main environmental factor worldwide. About 1 billion people live in iodine-deficient regions.<\/li>\n\n\n\n<li><strong>Dietary<\/strong>: The most important source of iodine (75 \u00b5g daily needed by thyroid; typical North American intake ~150\u2013300 \u00b5g\/day).<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Inherited Defects (Dyshormonogenetic Goiters)<\/h3>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Congenital<\/strong> enzyme defects in hormone synthesis (e.g., in NIS transporter, thyroglobulin, thyroid peroxidase, THOX2).<\/li>\n\n\n\n<li><strong>Pendred Syndrome<\/strong>: Thyroid iodide transport defect + sensorineural deafness (pendrin protein abnormality).<\/li>\n\n\n\n<li><strong>Thyroid Hormone Resistance<\/strong>: Mutations in thyroid receptor \u03b2 can cause euthyroid goiter with elevated T4\/T3.<\/li>\n<\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Evolution of Nontoxic Goiter<\/h3>\n\n\n\n<ol class=\"wp-block-list\">\n<li><strong>Early<\/strong>: Diffuse hyperplasia.<\/li>\n\n\n\n<li><strong>Prolonged TSH Stimulation<\/strong>: Nodule formation, partial encapsulation, hemorrhage, cystic change, calcification.<\/li>\n\n\n\n<li><strong>Involution<\/strong>: Epithelium flattens, colloid accumulates \u2192 large follicles and possible cysts.<\/li>\n\n\n\n<li><strong>Rarely<\/strong>, carcinoma may arise.<\/li>\n<\/ol>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>EUTHYROID (NONTOXIC) GOITER Definition and Overview Clinical Presentation Evaluation and Diagnosis Indications for Surgery GROSS PATHOLOGY OF GOITER Types and Frequency Physical Examination and Growth Gross Appearance Cytology and Histology ETIOLOGY OF NONTOXIC GOITER General Mechanism Inherited Defects (Dyshormonogenetic Goiters) Evolution of Nontoxic Goiter<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[683],"class_list":["post-4422357","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-thyroid-gland","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422357","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":6,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422357\/revisions"}],"predecessor-version":[{"id":4422858,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422357\/revisions\/4422858"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422357"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422357"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}