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Updated: May 2 2018

Nontoxic Goiter

  • 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
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