Yes, Goiter is a Common Manifestation of Graves' Disease in Adolescents
Goiter is a classic and expected finding in Graves' disease, including in pediatric patients, and this 13-year-old with confirmed Graves' disease can absolutely develop thyroid enlargement as part of their hyperthyroid presentation. 1
Understanding Goiter in Graves' Disease
Goiter is one of the cardinal features of Graves' disease and occurs due to autoantibody stimulation of thyroid hormone receptors, causing diffuse thyroid enlargement. 2 The pathophysiology involves:
- Thyroid-stimulating immunoglobulins (TSH receptor antibodies) bind to and activate thyroid hormone receptors, leading to both hormone overproduction and glandular hyperplasia 2
- The thyroid enlargement is typically diffuse rather than nodular in Graves' disease, distinguishing it from multinodular goiter 1
- Goiter is listed as one of the primary signs and symptoms of hyperthyroidism alongside tremors, nervousness, tachycardia, and heat intolerance 1
Clinical Significance in This Patient
For this specific 13-year-old patient weighing 30.5 kg:
- The presence of goiter would be consistent with and supportive of the Graves' disease diagnosis 2
- Diagnosis of Graves' disease is typically based on elevated free thyroxine (FT4) with suppressed TSH, often in the presence of diffuse goiter 1
- The goiter in Graves' disease is usually non-tender, though rare cases of painful goiter have been reported 3
Important Clinical Caveats
While goiter is typical, the diagnosis of Graves' disease does not require its presence—some patients may have minimal or no palpable thyroid enlargement. 1 Key considerations:
- Graves' disease can occasionally present with unilateral thyroid involvement, though this is rare 4
- The absence of thyroid mass or nodular goiter helps distinguish Graves' disease from toxic nodular disease 1
- Thyroid ultrasound can confirm diffuse enlargement and increased vascularity characteristic of Graves' disease 4
Why This Matters for Morbidity and Mortality
Recognizing goiter as part of Graves' disease is clinically important because untreated hyperthyroidism carries significant risks, particularly in pediatric patients:
- Adequate treatment is essential to prevent cardiovascular complications including tachycardia and potential heart failure 1
- Thyroid storm, though rare, represents a life-threatening complication of untreated or inadequately treated Graves' disease 1, 5
- The goiter itself may cause compressive symptoms if significantly enlarged, though this is more common in long-standing endemic goiter 6