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 Nontoxic (Simple): Diffuse & Multinodular References

  1. Bonnema SJ, Bennedbaek, Landenson PW, et al. Management of the nontoxic multinodular goiter: a North American survey. J Clin Endocrinol Metab. 2002 Jan;87(1):112-117. PMID: 11788632
  2. Baskin HJ, Cobin RH, Duick DS, et al; American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists medical guidelines for clinical practice for the evaluation and treatment of hyperthyroidism and hypothyroidism. Endocr Pract. 2002 Nov;8(6):457-469. PMID: 15260011
  3. Samuels MH. Evaluation and Treatment of sporadic nontoxic goiter - some answers and more questions. J Clin Endocrinol Metab. 2001 Mar;86(3):994-997. PMID: 11238475
  4. Hegedüs L, Bonnema SJ, Bennedbaek FN. Management of simple nodular goiter: current status and future perspectives. Endocr Rev. 2003 Feb;24(1):102-132. PMID: 12588812
  5. Disorders of the thyroid gland. Harrison's Online: McGraw-Hill Companies; 2003.
  6. Schlumberger MJ, Filetti S, Hay ID. Nontoxic diffuse and nodular goiter and thyroid neoplasia. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. William's Textbook of Endocrinology. 11th. Philadelphia: Saunders, an imprint of Elsevier; 2008.
  7. MedWormhttp://www.medworm.com/rss/index.php/Endocrinology/15/http://www.medworm.com/rss/medicalfeeds/specialities/Endocrinology.xml
  8. Malaysian Endocrine and Metabolic Society. Practice guidelines for thyroid disorders: the Malaysian consensus. Academy of Medicine Malaysia. http://www.acadmed.org.my/. 2000.
  9. Mulinda JR. Goiter. http://emedicine.medscape.com/article/120034-overview. 2006.
  10. Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association medical guidelines for clinical practice for the diagnosis and management of thyroid nodules. Endocr Pract. 2010 May;16(Suppl 1):1-43. http://serm.md/ghiduri/tiroida/AACE_AME_ETA_ Guidelines_for_Clinical_Practice_for_.pdf. PMID: 20497938
  11. Bahn RS, Castro MR. Approach to the patient with nontoxic multinodular goiter. J Clin Endocrinol Metab. 2011 May;96(5):1202-1212. doi: 10.1210/jc.2010-2583. PMID: 21543434
  12. Filetti S, Tuttle RM, Leboulleux S, Alexander EK. Nontoxic diffuse goiter, nodular thyroid disorders and thyroid malignancies. In: Melmed S, Auchus RJ, Goldfine AB et al, editors. Williams Textbook of Endocrinology. 14th ed. Philadelphia: Saunders, Elsevier; 2020.
  13. Nehs MA, Doherty GM. Nontoxic goiter. In: Cameron JL, Cameron AM, editors. Current Surgical Therapy. 13th ed. Philadelphia: Saunders, Elsevier; 2020.
  14. Ross DS. Clinical presentation and evaluation of goiter in adults. UpToDate. https://www.uptodate.com. 15 Sep 2020.
  15. Malaysian Endocrine and Metabolic Society (MEMS). Clinical practice guidelines: management of thyroid disorders. MEMS. http://www.mems.my/. 2019. Accessed 5 Oct 2020.
  16. Ross DS. Thyroid hormone suppressive therapy for thyroid nodules and benign goiter. UpToDate. https://www.uptodate.com. 18 Feb 2019.
  17. Ross DS. Treatment of nontoxic, nonobstructive goiter. UpToDate. https://www.uptodate.com. 28 May 2019. Accessed 12 Oct 2020.
  18. Ross DS. Treatment of obstructive or substernal goiter. UpToDate. https://www.uptodate.com. 17 Mar 2019.
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