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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 Treatment

Pharmacotherapy

Radioactive Iodine

  • An alternative to surgery especially in the elderly, patients unfit for surgery or with TSH suppression or patients wanting to avoid surgery
  • Reduces goiter size and reduces obstructive signs and symptoms (eg dyspnea and dysphagia)
Levothyroxine (T4)
  • May be an alternative to surgery and radioactive iodine therapy
  • More suitable for patients without thyroid-stimulating hormone (TSH) suppression or with high serum TSH levels
  • Has been used to prevent recurrences after surgery
  • Suppresses TSH production causing goiter shrinkage
  • Prolonged treatment with T4 is required to maintain goiter size reduction and prevent recurrences
    • Prolonged TSH suppression by T4 may also increase risk of bone loss and atrial fibrillation
  • Not recommended for treatment of nontoxic multinodular goiter due to its low efficacy and risk of thyrotoxicosis
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