• 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
  • 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
  • Pharmaceutic
    • levothyroxine
  • Hemorrhage into thyroid cyst
    • presents as painful, rapid growth of a portion of the thyroid

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