goiter%20nontoxic%20(simple)--%20diffuse%20-and-%20multinodular
GOITER NONTOXIC (SIMPLE): DIFFUSE & MULTINODULAR

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.

Pharmacotherapy

Radioactive Iodine

  • An alternative to surgery especially in the elderly, patients unfit for surgery or with TSH suppression
  • Reduces goiter size & reduces obstructive signs & symptoms (eg dyspnea & dysphagia)
Levothyroxine (T4)
  • May be an alternative to surgery & 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 & prevent recurrences
    • Prolonged TSH suppression by T4 may also increase risk of bone loss & atrial fibrillation
  • Not recommended for treatment of nontoxic multinodular goiter due to its low efficacy & risk of thyrotoxicosis
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