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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
    • 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
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