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.

Surgical Intervention

Subtotal Thyroidectomy or Near-Total Thyroidectomy

  • Reserved for euthyroid, substernal, large goiters with compression or progressive obstructive symptoms, malignancy and when other forms of treatment are not applicable to patient
  • Generally low morbidity when performed by experienced surgeon
  • Potential complications: Recurrent laryngeal nerve palsy, hypothyroidism and hypoparathyroidism
  • May administer low dose of T4 after surgery to suppress regrowth of goiter if serum TSH is elevated
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