Patient with a goiter

• enlargement of the thyroid gland

• endemic goiter is declared in an area with more than 10% of children with a goiter

• concerns: compressive symptoms (e.g. dysphagia) , malignancy, hyper-, or hypothyroidism

Causes of goiter

• endemic

  • iodine deficiency

  • goitrogens

  • genetic factors

• sporadic

  • iodine deficiency

  • goitrogens

  • genetic actors

  • enzyme deficiency

  • special circumstances: puberty, pregnancy, acromegaly

Causes of goiter

• TSH-mediated

  • iodine deficiency

  • iodine excess

  • goitrogens

  • enzyme deficiencies, sometimes familial

Symptoms

• pressure on and displacement of trachea

• difficulty breathing

• stridor

Pemberton’s sign

• color of face changes after patient raises his arm

Diagnosis

• palpation

• ultrasound

• thyroid function tests

Therapy: nontoxic goiter

• T4 suppression trial if patient is in upper range of normal

• surgery if obstructive

• ¹³¹I therapy offers limited reduction in size

Thyroid nodules: nontoxic

• incidence 5-10%

• identification: palpation, ultrasound

the dark areas on radiograph are areas with increased iodine uptake

Approach

• less than 10 mm in size: follow

• greater than 10 mm in size: aspirate to r/o malignancy

Goiter and thyroid nodules: important points

• causes

  • goiter

    • autoimmune, iodine deficiency, thyroiditis

  • nodules

    • clonal expansion of thyroid cells

Category: Pathology Notes