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Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters

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Abstract

Goiter, an enlargement of the thyroid gland, is a common problem in clinical practice associated with iodine deficiency, increase in serum thyroid-stimulating hormone (TSH) level, natural goitrogens, smoking, and lack of selenium and iron. Evidence suggests that heredity also has an important role in the etiology of goiter. The current classification divides goiter into diffuse and nodular, which may be further subdivided into toxic (associated with symptoms of hyperthyroidism, suppressed TSH or both), or nontoxic (associated with a normal TSH level). Nodular thyroid disease with the presence of single or multiple nodules requires evaluation due to the risk of malignancy, toxicity, and local compressive symptoms. Measurement of TSH, accurate imaging with high-resolution ultrasonography or computed tomography, and fine-needle aspiration biopsy are the appropriate methods for evaluation and management of goiter. This review discusses the clinical presentation, diagnostic evaluation, and treatment considerations of nontoxic diffuse and nodular goiters.

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Acknowledgments

The author acknowledges Milena Braga-Basaria for her valuable editorial suggestions and text editing.

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  1. Thyroid Unit, Division of Endocrinology and Metabolism, Hospital das Clínicas, University of São Paulo Medical School, Av. Dr. Enéas de Carvalho Aguiar, 155 – 8th floor, bl 3, PAMB, São Paulo, 05403-900, Brazil

    M. Knobel

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Knobel, M. Etiopathology, clinical features, and treatment of diffuse and multinodular nontoxic goiters. J Endocrinol Invest 39, 357–373 (2016). https://doi.org/10.1007/s40618-015-0391-7

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