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Thyroid Goiter

  • Lori A. Erickson
Chapter
Part of the Atlas of Anatomic Pathology book series (AAP)

Abstract

A goiter is an enlarged thyroid gland. Goiters may be simple or multinodular, dyshormonogenetic, toxic, endemic, or composed of amyloid. Simple nontoxic goiters usually are sporadic but may be endemic in areas of iodine deficiency. Endemic goiters are uncommon in modern times, with the use of iodized table salt. In the United States and other nonendemic areas, sporadic nontoxic goiters affect approximately 5 % of the population, are more common in women, and rarely affect young children. Although the etiology of sporadic nontoxic goiter is unknown, it likely is multifactorial. It may be associated with medications such as lithium, aminoglutethimide, propylthiouracil, and perchlorate; certain substances and foods (cassava, aniline derivatives, thiocyanates, perchlorates, and cyanoglucosides); and disruption of the hypothalamic pituitary axis, resulting increase of thyroid stimulating hormone. It also may have a hereditary component, particularly in women. Goiters also may occur in Cowden syndrome (germline PTEN mutation). Goiters usually are slow growing and may be associated with compressive and obstructive symptoms of dyspnea, stridor, hoarseness, and dilated neck veins. Goiters are treated with thyroxine, radioactive iodine, and surgery. A new nodule or sudden increase in growth is worrisome for malignancy. In a surgical series of 270 goiters, 7.7 % of which were suspected of being malignant, malignancy was identified in 33 cases (12.2 %). Nineteen were classic papillary thyroid carcinomas, two were a follicular variant of papillary carcinoma, three were lymphomas, three were medullary carcinomas, three were anaplastic carcinomas, two were follicular carcinomas, and one was a Hurthle cell carcinoma. An Italian study identified carcinoma in 13.7 % of goiters. A meta-analysis of 14 studies found that multinodular goiters were associated with a lower risk of cancer than single nodules, but a subgroup analysis suggested this difference depends on the inclusion of studies outside the United States. Unlike sporadic goiters, dyshormonogenetic goiters may develop in childhood, often are associated with hypothyroidism, and usually are the result of an autosomal recessive defect in thyroid hormone synthesis. Pendred syndrome includes congenital goiters and congenital sensorineural deafness and accounts for 10 % of hereditary deafness. The Pendred syndrome gene (7q22-31.1) encodes pendrin, an iodide/choride transporter. Toxic multinodular goiters are associated with thyrotoxicosis, which may develop insidiously. An autonomously hyperfunctioning nodule in a multinodular goiter has been referred to as Plummer disease. Amyloid goiters present as diffuse thyroid enlargement or a mass lesion. Patients often are asymptomatic but may have compressive symptoms and usually are euthyroid. Amyloid goiter also may occur in primary systemic amyloidosis and occasionally secondary amyloidosis, but secondary amyloidosis usually shows only focal involvement rather than diffuse replacement of the gland.

Keywords

Multinodular Goiter Endemic Goiter Cowden Syndrome Secondary Amyloidosis Nontoxic Goiter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Lori A. Erickson
    • 1
  1. 1.Mayo Clinic College of MedicineRochesterUSA

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