Goitre

Question 1

What is the definition of a goitre?

Answer 1

Swelling of the neck/larynx due to enlargement of the thyroid

Question 2

How common is a goitre?

Answer 2

Between 4-7% of adults have palpable thyroid lumps

Question 3

What is the pathophysiology of a goitre?

Answer 3

• Diffuse smooth goitre: entire thyroid gland is larger than normal but smooth
• Simple goitre – no clear cause, smooth and soft, associated with Graves
• Autoimmune e.g. Hashimotos – firm diffuse goitre
• Thyroiditis e.g. de Quervains
• Nodular goitre: small lump in the thyroid.
• Single/solitary nodule – e.g. cyst, benign/malignant tumour
• Multi-nodular – e.g. old age, toxic multinodular goitre

Question 4

What are the risk factors/aetiology of a goitre?

Answer 4

• Iodine deficiency: thyroid swells to compensate in making more T3/T4 - diffuse smooth goitre
• Grave’s disease - diffuse smooth goitre
• Thyroiditis caused by Hashimotos, infection or radiotherapy - diffuse smooth goitre
• Drugs e.g. lithium, amiodarone - diffuse smooth goitre
• Hereditary factors - diffuse smooth goitre
• Pregnancy/puberty/menopause - diffuse smooth goitre

Question 5

What are the signs/symptoms of a goitre?

Answer 5

• Swelling of the neck
• Mostly painless – unless thyroiditis
• Hyperthyroid/hypothyroid symptoms
• When swallowing does the lump move? – thyroid lumps and thyroglossal cysts move upwards on swallowing
• Protruding tongue – thyroglossal cyst moves up
• Bruit
• Difficulty swallowing - REDFLAG
• Stridor - REDFLAG
• Hoarseness of voice - REDFLAG
• Enlarged lymph nodes - REDFLAG

Question 6

What investigations are carried out for goitres?

Answer 6

• TFTs/Thyroid antibodies
• Thyroid US +/- biopsy or fine needle aspiration
• Thyroid x-ray
• Basal plasma calcitonin and cardinoembryonic antigen – if thyroid cancer is suspected

Question 7

What are the surgical treatments for a goitre?

Answer 7

• Partial/full thyroidectomy

Question 8

What are the pharmacological treatments for a goitre?

Answer 8

• Levothyroixine
• Radioactive iodine
• Iodine replacement

Question 9

What are the non pharmacological treatments for a goitre?

Answer 9

• No symptoms/cancer = no treatment