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Goitres

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

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Goitre

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

Which surrounding structures may a large goitre compress? Which symptoms would result?

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What is Pemberton sign?

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Try some thyroid stations

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