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.

Pharmacotherapy

Levothyroxine (T4)

  • May be an alternative to surgery & radioactive iodine therapy
  • More suitable for patients w/o thyroid-stimulating hormone (TSH) suppression or w/ high serum TSH levels
  • Has been used to prevent recurrences after surgery
  • Actions: Suppresses TSH production causing goiter shrinkage
  • Effects based on clinical studies in the management of nontoxic goiter:
    • Goiter size decreases by 25% in 9 months in 51% of patients
  • Not recommended for treatment of nontoxic multinodular goiter due to its low efficacy & risk of thyrotoxicosis
  • Prolonged treatment w/ T4 is required to maintain goiter size reduction & prevent recurrences
    • Prolonged TSH suppression by T4 may also increase risk of bone loss & atrial fibrillation

Radioactive Iodine

  • As an alternative to surgery (especially in elderly, patients unfit for surgery or w/ TSH suppression)
  • Effects based on clinical study in the management of nontoxic goiter:
    • Goiter size decreases by 45% in 2 years in 97% of patients (the greatest reduction in goiter size during the 1st years)
    • Recurrence rate: 8% after 3-5 years
    • Reduces obstructive signs & symptoms (eg tracheal lumen widened by up to 36%; improvement in stridor & dyspnea)
    • Normalize serum TSH w/o causing hypothyroidism
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Tee Hoi Poh, 26 Sep 2018
Stool-based colorectal cancer (CRC) screening should be the preferred method of CRC screening in Malaysia, according to Dato Dr Muhammad Radzi Abu Hassan, the Head of Gastroenterology Services in Ministry of Health, Malaysia, who presented the Malaysian experience on CRC screening at the Annual Scientific Meeting of the Society of Gastroenterology and Hepatology (GUT) 2018 held recently in Penang.
Jackey Suen, 26 Nov 2018

Linagliptin has no impact on cognitive decline when given on top of standard of care in patients with type 2 diabetes mellitus (T2DM), a CARMELINA substudy has shown.