Table of Contents
A goitre is the term used for an enlarged thyroid gland.
Most common causes in the UK
- Graves’ disease
- Multinodular goitre (NB: a multinodular is an ultrasound diagnosis because they usually feel smooth or only slightly irregular)
- Physiological goitre (pregnancy/puberty)
Classification of possible causes
- Diffuse
- Simple = euthyroid gland enlargement without inflammation or cancer (e.g. physiological, iodine deficiency)
- Autoimmune (e.g. Graves’ disease, Hashimoto’s thyroiditis)
- Infective (e.g. acute viral/De Quervain’s thyroiditis) – painful
- Iatrogenic (e.g. lithium, amiodarone)
- Nodular
- Multinodular goitre (euthyroid)
- Toxic multinodular goitre (hyperthyroid)
- Solitary nodule (e.g. cancer, adenoma, cysts)
Investigations
- Thyroid function tests
- Thyroid autoantibodies: TSH-receptor antibodies, thyroid peroxidase antibodies, thyroglobulin antibodies
- Imaging
- Ultrasound
- Radioiodine uptake scan
- CT (if retrosternal)
- Ultrasound-guided fine needle aspiration
Management
- Conservative: if patient is euthyroid, reassure
- Medical: make patient euthyroid
- Hyperthyroid: β-blocker (symptomatic), carbimazole (thyroid peroxidase inhibitor), radioiodine-131 therapy
- Hypothyroid: thyroxine
- Surgical thyroidectomy/resection if:
- Malignant
- Compression of surrounding structures
- Cosmetic
- Alternative option for treating hyperthyroidism
Complications
- Hyper/hypothyroidism
- Compression of surrounding structures
- Trachea compression → breathlessness
- Recurrent laryngeal nerve damage → dysphonia
- Oesophageal compression → dysphagia
- Superior vena cava obstruction → facial swelling, dizziness, headache, blurred vision, syncope
- Pre-ganglionic Horner’s syndrome → ptosis, meiosis, anhidrosis
- Cosmetic issues
