Nontoxic Goiter

Introduction

• Thyroid enlargement as a result of thyroid hormone deficiency
  • initially, TH deficiency leads to uniform follicular epithelial hyperplasia as the thyroid gland attempts to compensate 
  • over time, thyroid architecture loses uniformity, leading to the areas of involution and fibrosis interspersed with areas of focal colloid hyperplasia
• Several types
  • endemic (most common type)
    • caused by iodide deficiency 
  • sporadic
    • caused by puberty, pregnancy, enzyme deficiency
• Nontoxic means that the gland still depends on TSH stimulation
• goiter becomes toxic when hyperplasia becomes independent of TSH

Presentation

• Symptoms
  • hoarseness
    • due to compression of laryngeal nerve
  • dyspnea
    • due to compression of trachea
• Physical exam
  • diffuse thyromegaly (early)
  • multinodular goiter (late)
  • Pemberton’s sign
• compression of jugular vein leading to neck congestion

Treatment

• Pharmaceutic
• levothyroxine

Complications

• Hemorrhage into thyroid cyst
  • presents as painful, rapid growth of a portion of the thyroid