From the Guidelines
Yes, you can have a thyroid goiter with normal thyroid function tests (TFTs). A goiter simply refers to an enlarged thyroid gland, which can occur even when the thyroid is producing normal amounts of hormones (euthyroid state). This is called a euthyroid or nontoxic goiter. Common causes include iodine deficiency, autoimmune thyroiditis (Hashimoto's disease) before thyroid function becomes impaired, multinodular goiters, and certain medications. The enlargement happens because the thyroid tissue grows in response to various stimuli, but may still maintain normal hormone production.
Some key points to consider:
- If you discover a goiter, you should seek medical evaluation even with normal TFTs, as your doctor may recommend ultrasound imaging to assess the structure of the thyroid and possibly a biopsy if nodules are present.
- Regular monitoring is important as some goiters may eventually affect thyroid function over time or cause local symptoms like difficulty swallowing, breathing problems, or voice changes due to compression of surrounding structures in the neck.
- The presence of thyroid autoantibodies (antithyroid peroxidase [TPO] and antithyroglobulin [TG]) identifies patients at increased risk for thyroid autoimmunity, as noted in studies such as 1.
- Patients with elevated TSH levels should be treated with thyroid hormone replacement therapy, while comprehensive evaluation and treatment of hyperthyroidism should be initiated in patients with suppressed TSH and elevated T4/T3 levels.
It's essential to follow the guidance of a healthcare professional for proper evaluation and management of a thyroid goiter, even if thyroid function tests are normal, to prevent potential complications and ensure optimal health outcomes.
From the Research
Thyroid Goiter and Normal Thyroid Function Tests
- A thyroid goiter refers to an enlarged thyroid gland, which can be caused by various factors such as autoimmune disease, thyroid nodules, and iodine deficiency 2.
- Patients with goiter may have normal thyroid function tests (TFTs), also known as nontoxic goiters, which are characterized by a normal thyroid-stimulating hormone (TSH) level 3.
- Nontoxic goiters can be further divided into diffuse and nodular types, and may require evaluation due to the risk of malignancy, toxicity, and local compressive symptoms 3.
- Measurement of TSH, accurate imaging with high-resolution ultrasonography or computed tomography, and fine-needle aspiration biopsy are the appropriate methods for evaluation and management of goiter 3.
Causes and Treatment of Goiter
- The main causes of simple diffuse goiter (SDG) and multinodular goiter (MNG) are iodine deficiency, increase in serum TSH level, natural goitrogens, smoking, chronic malnutrition, and lack of selenium, iron, and zinc 4.
- Treatment of SDG and MNG still focuses on L-thyroxine-suppressive therapy and surgery, with radioiodine alone or preceded by recombinant human TSH stimulation also being used in some cases 4.
- Iodine therapy may be used to treat iodine deficiency goiter, but it is important to monitor for potential antibody reactions, which can occur in some patients 5.
Diagnosis and Management of Thyroid Dysfunction
- Clinical hypothyroidism is diagnosed based on blood levels of TSH and free thyroxine, and symptom relief and normalized TSH levels are achieved with levothyroxine replacement therapy 6.
- Patients with goiter and normal TFTs may still require regular monitoring and evaluation to ensure that their condition does not progress to hypothyroidism or hyperthyroidism 2, 3.