From the Guidelines
A goiter is an abnormal enlargement of the thyroid gland that presents as a swelling in the anterior neck, which can be classified as diffuse or nodular, and may be non-toxic, toxic, or associated with hypothyroidism. On physical examination, the goiter appears as a visible or palpable enlargement that moves upward with swallowing 1. Goiters can be caused by various factors, including iodine deficiency, autoimmune disorders like Hashimoto's thyroiditis or Graves' disease, thyroiditis, thyroid nodules, or thyroid cancer. When documenting a goiter, it is essential to note its size, consistency, tenderness, presence of nodules, and any associated symptoms like dysphagia, dysphonia, or dyspnea suggesting compression of adjacent structures 1.
Some key points to consider when describing a goiter include:
- Size: often described in WHO classification grades I-III
- Consistency: soft, firm, or hard
- Tenderness: presence or absence
- Presence of nodules: number, size, and characteristics
- Associated symptoms: dysphagia, dysphonia, or dyspnea
- Laboratory findings: thyroid function tests (TSH, free T4, free T3) and imaging results if available 1.
Ultrasound (US) is the preferred first-line imaging modality for suspected goiter, as it confirms that the neck mass is arising from the thyroid and characterizes the size and morphology of the goiter 1. This comprehensive description helps establish the etiology of the goiter and guides appropriate management decisions.
From the Research
Description of Goiter
- Goiter refers to an enlarged thyroid gland, which can be asymptomatic or cause compression of surrounding structures such as the esophagus and/or trachea 2
- It can be described as a benign enlargement of the thyroid gland, with options for medical treatment limited to thyroxine hormone suppression and radioactive iodine ablation 2
- Goiter may present with compressive symptoms such as cough or dysphagia, and may also present with symptoms due to associated hypothyroidism or hyperthyroidism 3
Clinical Features
- Patients with goiter may be asymptomatic, or may present with symptoms such as dyspnea, orthopnea, and dysphagia, particularly with substernal goiters 2
- Goiter may be associated with systemic thyrotoxic symptoms, or may be nontoxic with normal TSH levels 4
- The serum TSH level is a sensitive and reliable index of thyroid function, and thyroid ultrasound has become an extension of physical examination to determine what nodules should be biopsied 4, 3
Diagnostic Evaluation
- Diagnostic evaluation of patients with goiter consists of clinical evaluation, biochemical testing, fine-needle aspiration (FNA), and imaging studies such as chest radiography, high-resolution ultrasonography, and computed tomography 4, 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 5
Treatment Options
- Treatment options for goiter depend on the cause and the clinical picture, and may include observation, iodine supplementation, thyroxine suppression, thionamide medication, radioactive iodine ablation, and surgery 3, 6
- Indications for surgery in goiter include a well-founded suspicion of malignancy, local compressive symptoms, and, rarely, cosmesis 6