Goiter Nontoxic (Simple): Diffuse & Multinodular Signs and Symptoms

Introduction

• Thyroid enlargement unrelated to hypothyroidism, hyperthyroidism, inflammation or neoplasia

Etiology

• Etiology is usually unknown
  
  • Known causes include: Iodine deficiency, iodine excess, goitrogen ingestion, autoimmune disorders (eg Hashimoto's thyroiditis), thyroid hormone production defects and certain medications
• There is a female preponderance of nontoxic diffuse goiter

Signs and Symptoms

• Usually asymptomatic
• Symptomatic patient may present with the following:
  
  • Painless neck swelling
  • Cosmetic complaints
  • Shortness of breath
  • Sudden increase in goiter size with pain due to hemorrhage
  • Large goiter causing obstructive signs eg dysphagia, choking sensation, stridor, plethora (venous congestion)
  • Pemberton’s sign - faintness with facial congestion, external jugular venous blockage when both arms are raised above head (an action that draws the thyroid into the thoracic inlet)