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

Complications

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