Goiter

Epidemiology

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Etiology

• Iodine deficiency (leading cause of goiter worldwide)
• Inflammation (e.g., Hashimoto thyroiditis (painless), subacute granulomatous thyroiditis (painful))
• Graves disease
• Thyroid cysts (e.g., thyroglossal cyst)
• Thyroid adenomas
• Thyroid carcinomas
• Physiological goiter: In puberty & pregnancy, hormones like hCG (during pregnancy) and potentially FSH/LH (during puberty) have a weak TSH-like effect, stimulating thyroid growth.

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Classifications

Morphology

• Growth pattern of goiter
  • Diffuse goiter: diffusely enlarged thyroid
    • Graves disease
    • Inflammation (e.g., Hashimoto thyroiditis)
    • TSH-secreting pituitary adenoma
    • Iodine deficiency
  • Nodular goiter: irregular enlarged thyroid due to nodule formation
    • Uninodular goiter (e.g., cysts, adenoma, cancer)
    • Toxic and nontoxic multinodular goiter

Thyroid function of goiter

• Nontoxic goiter: normal TSH, fT3, and fT4 levels
  • E.g., Iodine deficiency
• Toxic goiter: increased thyroid hormone production
  • E.g., Graves disease, toxic multinodular goiter
• Hypothyroid goiter: decreased thyroid hormone production
  • E.g., Hashimoto’s disease, congenital hypothyroid goiter

Dignity of goiter

• Malignant goiter: e.g., thyroid carcinoma
• Benign (bland) goiter: benign thyroid enlargement

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Clinical features

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Diagnostics

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Treatment

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