A goiter is an enlarged thyroid gland, either smooth (diffuse) or lumpy (multinodular). Worldwide the main cause is lack of iodine, while in the US it is more often autoimmune disease or nodules, and thyroid function can be normal, high or low.
Key symptoms
- Swelling at the front of the neck
- Tightness in the throat or trouble swallowing
- Shortness of breath or noisy breathing when lying flat
- Hoarse voice
- Symptoms of high or low thyroid function
What you find on exam
- Inspect from the front and as the patient swallows
- Palpate from behind for size, texture and nodules
- Tracheal deviation and enlarged lymph nodes
- Pemberton sign: facial flushing with raised arms suggests growth behind the sternum
- Pulse, tremor, reflexes and eye signs
Tests
- TSH first, then free T4
- Thyroid antibodies (TPO) if function is abnormal
- Neck ultrasound: size and nodules
- Fine needle aspiration of suspicious nodules; CT if it extends into the chest
Treatment basics
- Small goiters with normal function and no symptoms: watch and monitor
- Levothyroxine if hypothyroid
- Hyperthyroidism: methimazole, radioactive iodine or surgery
- Surgery for compression, suspected cancer or large extension into the chest
- Iodized salt where iodine intake is low
Red flags
- Stridor or trouble breathing
- Fast-growing hard mass or a fixed lymph node
- New hoarseness or trouble swallowing
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.