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goiter
Enlargement of the thyroid gland.
Etiology:
- iodine deficiency is most common cause worldwide [1]
- autoimmune thyroiditis
- Hashimoto's thyroiditis
- Riedel thyroiditis (IgG4 disease-related)
History:
- iodine intake
- rate of change in size
- thyroid cancer risk factors (radiation exposire, family history)
Clinical manifestations:
- enlargement of the thyroid gland
Laboratory:
- thyroid function testing
- serum TSH (all patients)
- if low, free T4 & serum T3 (+ thyroid scintigraphy)
- if normal or high, thyroid ultrasound (see Radiology)
Special laboratory:
- flow-volume-loop study in patients at risk for or with symptoms of airway obstruction (tracheal lumen < 1 cm in diameter)
Radiology:
- ultrasound of thyroid (& neck)
- serum TSH normal or high AND
- risk factors for thyroid cancer, palpable thyroid nodules, thyroid gland asymmetry, large goiters, rapid growth or thoracic outlet syndrome
- thyroid scintigraphy if serum TSH is low
- avoid iodinated contrast to avoid precipitating iodine-induced hyperthyroidism
Complications:
- compression of adjacent structures
- thoracic outlet syndrome
- compression of trachea
- hyperthyroidism or hypothyroidism
Management:
- replacement of thyroid hormone to suppress elevated serum TSH
- thyroid surgery (surgical resection)
Specific
diffuse goiter; simple goiter; colloid goiter
multinodular goiter
General
sign/symptom
thyroid disease
References
- Medical Knowledge Self Assessment Program (MKSAP) 18, 19
American College of Physicians, Philadelphia 2018, 2022