Introduction Thyroid enlargement as a result of thyroid hormone deficiency initially, TH deficiency leads to uniform follicular epithelial hyperplasia as the thyroid gland attempts to compensate over time, thyroid architecture loses uniformity, leading to the areas of involution and fibrosis interspersed with areas of focal colloid hyperplasia Several types endemic (most common type) caused by iodide deficiency sporadic caused by puberty, pregnancy, enzyme deficiency Nontoxic means that the gland still depends on TSH stimulation goiter becomes toxic when hyperplasia becomes independent of TSH Presentation Symptoms hoarseness due to compression of laryngeal nerve dyspnea due to compression of trachea Physical exam diffuse thyromegaly (early) multinodular goiter (late) Pemberton's sign compression of jugular vein leading to neck congestion Treatment Pharmaceutic levothyroxine Complications Hemorrhage into thyroid cyst presents as painful, rapid growth of a portion of the thyroid