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diffuse goiter; simple goiter; colloid goiter
A euthyroid form of goiter that diffusely involves the entire gland without nodularity.
Etiology:
- multifactorial
- endemic goiter
- hereditary biosynthetic defects in thyroid hormone synthesis
- iodine transport defect
- organification defects
- dehalogenase defect
- iodotyrosine coupling defect
Epidemiology:
- non endemic form much less common than endemic form
- female:male ratio 8:1
- peak incidence at puberty or young adult
Pathology:
- hyperplastic stage
- variable in duration
- columnar follicular epithelium
- scant colloid
- thyroid gland rarely exceeds 100-150 grams
- euthyroid state achieved through hyperplasia
- colloid involution
- follicular growth ceases
- colloid accumulation (not uniform)
- thyroid may be > 500 grams
- epithelium undergoes progressive flattening
Clinical manifestations:
- depends largely on ability to maintain euthyroid state & occurrence of complications
- dysphagia or odynophagia may result from esophageal compression
Laboratory:
- normal serum T4 & free T4
- normal serum TSH
Special laboratory:
- ultrasound not recommended if asymptomatic, stable [2]
Complications:
- diffuse goiter may transform into multinodular goiter
- compression of trachea or esophagus
- mediastinal compression & superior vena cava syndrome when enlarged goiter is retrosternal
Management:
- observation if asymptomatic, stable [2]
- thyroidectomy if compression of adjacent structures [2]
Related
multinodular goiter
Specific
endemic goiter
General
goiter
References
- Cotran et al Robbins Pathologic Basis of Disease,
5th ed. W.B. Saunders Co, Philadelphia, PA 1994 pg 1131
- Medical Knowledge Self Assessment Program (MKSAP) 11, 16, 17.
American College of Physicians, Philadelphia 1998, 2012, 2015