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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