Goiter

Goiter 

Updated: 12/13/2020

© Jun Wang, MD, PhD

General features
  • Enlargement of thyroid
  • Due to impaired synthesis of thyroid hormone, most commonly iodine deficiency
  • Compensatory hypertrophy and hyperplasia of thyroid glands due to elevated TSH
  • Either diffuse or multinodular goiter
Diffuse nontoxic (simple) goiter
  • Enlargement of thyroid without nodularity
  • Endemic goiter due to iodine deficiency or goitrogens, such as certain vegetables
  • Sporadic goiter: Female preponderance, peak incidence at puberty or young adults, may be associated with hereditary thyroid hormone synthesis defects
  • Two phases: hyperplastic phase (similar to Graves disease) and colloid involution (accumulation of colloid)
  • Usually clinically euthyroid with elevated TSH
  • Eventually converts into multinodular goiter
Multinodular goiter
  • Irregular enlargement of thyroid gland
  • Associated with repeated episodes of hyperplasia and involution (degeneration)
  • May resemble a neoplasm
  • Usually normal T3 and T4 , normal radioactive iodine uptake, thyroglobulin may be elevated
  • Asymmetric, cystic and hemorrhagic with brown gelatinous colloid nodules with focal calcification
  • Dilated follicles of varying sizes with flattened to hyperplastic epithelium
  • Treatments: Thyroxine, radioactive iodine, surgery etc
Plummer syndrome
  • Toxic multinodular goiter
  • Autonomous nodule associated hyperthyroidism
  • Somatic mutations of TSH receptor
  • Symptoms of hyperthyroidism, but no ophthalmopathy and dermopathy in Graves disease
  • May develop malignancy

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