Goitres

A goitre is the term used for an enlarged thyroid gland.

Most common causes in the UK

1. Graves’ disease
2. Multinodular goitre (NB: a multinodular is an ultrasound diagnosis because they usually feel smooth or only slightly irregular) 
3. 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
• Cosmetic issues

Here are some questions for you

Try some thyroid stations

1. Thyroid exam
2. Graves’ disease
3. Hashimoto’s thyroiditis
4. Find more OSCE stations here