goiter%20nontoxic%20(simple)--%20diffuse%20-and-%20multinodular
GOITER NONTOXIC (SIMPLE): DIFFUSE & MULTINODULAR
Treatment Guideline Chart

Nontoxic diffuse 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.

Diagnosis of exclusion to rule out goiter due to hypothyroidism, hyperthyroidism, autoimmune thyroiditis, invasive fibrous thyroiditis, medications & iodine deficiency or excess.

Goiter%20nontoxic%20(simple)--%20diffuse%20-and-%20multinodular Management

Monitoring

  • For patients who are asymptomatic, with normal thyroid functions and small goiters, and when the benefit of nontreatment outweighs the risk of treatment
  • Monitor serum thyroid stimulating hormone (TSH) regularly and maintain in a low detectable range
  • Periodically evaluate with ultrasound measurements
  • Risk of nontreatment: Goiter growth and progression, hyperthyroidism or hypothyroidism
  • Based on clinical studies in the management of nontoxic goiter:
    • Goiter size increases yearly and large goiters with 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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