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.

Surgical Intervention

Subtotal Thyroidectomy/Near-Total Thyroidectomy

  • Reserved for large goiters w/ compression, malignancy & when other forms of treatment are not applicable to patient
  • Based on clinical studies in the management of nontoxic goiter:
    • Goiter size reduces by 100% w/in a few hours after surgery
    • Recurrence rate: 4-20% but increases w/ longer follow up periods (28% after 10 years, 40% after 30 years) 
  • Generally low morbidity when performed by experienced surgeon
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