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Goiter

Rudolph M. Krafft, MD, FAAFP and Jessica L. Handel, DO Reviewed 06/2018
 


BASICS

DESCRIPTION

  • Any enlargement of the thyroid gland

  • Classification on the basis of

    • Location (cervical vs. substernal)

    • Morphology (diffuse vs. nodular)

    • Functional status (hypothyroid, euthyroid, or hype...

DIAGNOSIS

HISTORY

  • Neck swelling, patient or physician noted

  • Usually asymptomatic

  • Pain (thyroiditis)

  • Incidental finding on imaging, especially with substernal goiter

  • Occasional obstructive symptoms

    • Dysphagia...

TREATMENT

MEDICATION

First Line

  • Hypothyroid—L-thyroxine

  • Hyperthyroid—iodine-131 (I-131), antithyroid drugs, and surgery all considered reasonable options. The choice of therapy depends on symptoms, size ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Ultrasound annually for nodular goiter

  • TSH annually for euthyroid goiters to detect development of hypothyroidism in thyroiditis or hyperthyroidi...

REFERENCES

1
Constantinides V, Palazzo F. Goitre and thyroid cancer. Medicine.  2013;41:546–550.
2
Gharib H, Papini E, Paschke R, et al. American Association of Clinical Endocrinologists, Associazio...

CODES

ICD10

  • E04.9 Nontoxic goiter, unspecified

  • E04.2 Nontoxic multinodular goiter

  • E05.00 Thyrotoxicosis w diffuse goiter w/o thyrotoxic crisis

  • E03.0 Congenital hypothyroidism with diffuse goiter

  • E04.1 Nont...

CLINICAL PEARLS

  • TSH is best initial screening test for both hypothyroidism and hyperthyroidism.

  • Any nodule with suspicious features by history, exam, or ultrasound should be biopsied.

  • Treatment of goite...

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