A goitre is the term used for an enlarged thyroid gland.
Most common causes in the UK
- Gravesβ 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. Gravesβ disease, Hashimotoβs thyroiditis)
- Infective (e.g. acute viral/De Quervain’s thyroiditis) β 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-guided fine needle aspiration
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Management
- Conservative: if patient is euthyroid, reassure
- Medical: make patient euthyroid
- Hyperthyroid: Ξ²-blocker (symptomatic), carbimazole (thyroid peroxidase inhibitor), radioiodine-131 therapy
- Surgical thyroidectomy/resection if:
- Compression of surrounding structures
- 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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