{"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\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&hellip;<\/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"],"_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}]}}