Diagnosis

Treatment after surgery on euthyroid goitre (total thyroidectomy)

Introduction1,2

The term goitre refers to any enlargement of the thyroid that may, depending on its morphological characteristics, be diffuse or nodular (uni- or multi-nodular) and coexist from a functional point of view with euthyroidism, hypothyroidism or hyperthyroidism (toxic goitre). Simple goitre is a diffuse or nodular enlargement of the thyroid, which is neither inflammatory nor neoplastic, in an euthyroid individual.

Goitre types1-3

TOXIC
  • Simple goitre
  • Endemic goitre / Iodine deficiency
  • Dyshormonogenesis goitre
  • Goitre induced by goitre-generating substances
  • Lymphocytic goitre
  • Riedel thyroiditis (rare)
  • Subacute or De Quervain’s thyroiditis (note: it may occur with transient hyperthyroidism)
  • Acute or suppurative thyroiditis (note: it may occur with transient hyperthyroidism)
  • Goitre associated with hypothyroidism
NON-TOXIC
  • Multi- or uninodular: secretory adenoma
  • Graves’ disease (diffuse "toxic" goitre)
  • Destructive thyroiditis with goitre
NEOPLASTIC/MALIGNANT
  • Carcinomas (papillary, follicular, medullary, undifferentiated)
  • Lymphoma
  • Distant metastases

Signs, symptoms and causes1,2

Signs and symptoms
  • Compression: manifests in high dyspnoea and dysphagia in very large goitres (rare)
  • Paralysis of a vocal chord (very rare; query malignancy)
  • Generally, euthyroidism (but may develop into hypo or hyperthyroidism)
Causes
  • Goitre is a benign change in the thyroid (hyperplasia), which may be trying to compensate for poor thyroid hormone production.
  • It is normally familial and more often affects females

Diagnostic Methods1,4,5

Physical examination

 

Laboratory tests

Serum thyroid hormone levels (TSH, free T4 and T3) in simple goitre are generally within normal range.

Thyroid ultrasound

Echo-guided fine needle cytology (mainly directed at solid, hypoechoic nodule, larger than 1 cm or other suspect findings)

Cytology should be preceded by a TSH measurement. Patients with low TSH should be considered for scintigraphy prior to cytology.

Thyroid scintigraphy

To be performed only in certain situations, e. g. hyperthyroidism associated with nodules.