goiter%20nontoxic%20(simple)--%20diffuse%20-and-%20multinodular
GOITER NONTOXIC (SIMPLE): DIFFUSE & MULTINODULAR
Nontoxic goiter is thyroid enlargement unrelated to hypothyroidism, hyperthyroidism, inflammation or neoplasia.
Etiology is usually unknown. Some known causes include iodine deficiency, iodine excess, goitrogen ingestion, autoimmune disorders, thyroid hormone production defects and certain medications.
It is usually asymptomatic.
Symptomatic patient may present with painless neck swelling, cosmetic complaints, shortness of breath, sudden increase in goiter size with pain due to hemorrhage, larger goiter causing obstructive signs eg dysphagia, choking sensation and Pemberton's sign.

Monitoring

  • For patients who are asymptomatic, w/ normal thyroid functions & small goiters, & when the benefit of nontreatment outweighs the risk of treatment
  • Monitor serum thyroid stimulating hormone (TSH) regularly & maintain in a low detectable range
  • Risk of nontreatment: Goiter growth & progression, hyperthyroidism or hypothyroidism
  • Based on clinical studies in the management of nontoxic goiter:
    • Goiter size increases by 4.5% per year & large goiters w/ obstructive symptoms may develop
    • Goiter growth potential does vary greatly between patients
    • 10% of the patients develop hyperthyroidism/thyrotoxicosis after 7-12 years
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