Euthyroid goitre

Approach to a euthyroid goiter.

Sources used:

1. The Journal of Family Practice at http://www.jfponline.com/Pages.asp?AID=5072
2. eTG (requires subscription)

One of the precepts of medicine is to “first do no harm,” and care of the patient with goiter is an excellent opportunity to practice this approach. - John P. Langlois, MD

Overview
Start with a history, physical exam, and thyroid ultrasound; patients with a reassuring workup can be followed clinically.

Provisional dx: Multinodular goiter
Differential dx: Diffuse goiter (often idiopathic), thyroiditis, and neoplasms

Etiology of non-toxic goiter

1. Endemic: too much iodine (eg. Japan- seafood diet), too little iodine (eg. mountainous regions)
2. Sporadic: inherited, poor diet, age >40, female sex

Investigations

• Thyroid ultrasounds: Thyroid ultrasound is less expensive and less invasive than other imaging modalities, provides excellent visualization of thyroid structure and the nature of cysts and nodules, and allows for estimation of thyroid size.
• Thyroid function tests: Confirm euthyroid state

** The malignant potential in multinodular goiter (2%–4%) is similar to that of solitary nodules (4%–6%).³ Therefore, any dominant nodule in a multinodular goiter should be evaluated the same way one would evaluate a solitary nodule.

Management & Follow-up

• Reassuring initial work-up: Serial clinical evaluations - yearly exams and TSH testing are considered adequate by some experts.
  Note: A few non-benign conditions such as thyroiditis and neoplasm can sometimes present in a euthyroid state, the clinician should be alert for any physical exam or laboratory changes. If any changes occur, then further workup is indicated.
  
  Suppressive therapy with thyroxine is an option for decreasing thyroid size in euthyroid goiter, but this therapy remains controversial due to side effects.
• If local compression or aethetics is a problem consider surgical reduction.

**See the disclaimer**