Goitre
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Introduction

Goitre refers to an enlarged palpable thyroid gland, which moves on swallowing. It may be a benign disorder but is also associated with several thyroid diseases, including iodine deficiency (common in the developing world, and may or may not cause hypothyroidism), Hashimoto’s thyroiditis (a type of hypothyroidism), as well as some of the causes of hyperthyroidism.

  • Best assessed via USS
    • If TSH low, also consider a radionuclide scan
  • Not necessarily indicative of disease
  • Simple Goitre – typically associated with normal thyroid hormone levels, no treatment necessary
  • Multinodular Goitre – progresses with age, secrete autonomously, many nodules can cause hyperthyroidism
  • Most common causes;
    • Problems with thyroid function (hypo or hyperthyroidism)
    • Endemic
    • Sporadic non-toxic
Thyroid gland
Image modified from original images taken from SMART by Servier Medical Art by Servier and is licensed under a Thyroid gland. Creative Commons Attribution 3.0 Unported License
Endemic – when over 5% of the children in a population have a goitre (can exceed 30%)
  • Affects over 200 million people worldwide, caused by iodine deficiency or ‘goitrogens’ (chemicals found in food that exaggerate the effects of iodine deficiency eg. Cassava, selenium, cabbage).
  • Usually diffuse goitre, becoming nodular with age, rarely compressing.
  • Treated with iodine supplements, iodized salt/water
Sporadic – unknown cause
  • 5% population, M:F – 1:4. Incidence declines with age.
  • Usually changes from diffuse to multinodular. TSH levels are normal. Nodules from an entire follicle rather than a single cell. Mostly visible, with compression on the neck.
  • Should be left alone unless causing pain or significant compression

References

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Dr Tom Leach

Dr Tom Leach MBChB DCH EMCert(ACEM) currently works as a GP Registrar and an Emergency Department CMO in Australia. He is also a Clinical Associate Lecturer at the Australian National University. After graduating from his medical degree at the University of Manchester in 2011, Tom completed his Foundation Training at Bolton Royal Hospital, before moving to Australia in 2013. He started almostadoctor whilst a third year medical student in 2009. Read full bio

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