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Nontoxic Nodular Goiter

(Sporadic Goiter; Simple Goiter; Nodular Enlargement of the Thyroid Gland)

Definition

A goiter is an enlargement of the thyroid. The thyroid is a gland. It produces hormones that help regulate your body’s metabolism. It is located on the front of the neck, right below the Adam’s apple. Goiters are seldom painful. They tend to grow slowly.
There are different types of goiters. This sheet focuses on nontoxic (or sporadic) goiter. It is a type of simple goiter that may be:
The development of nodules marks a progression of the goiter. It should be evaluated by your doctor.
Goiter (Enlargement of the Thyroid Gland)
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Causes

The exact causes of nontoxic goiter are not known. In general, goiters may be caused by too much or too little thyroid hormones. There is often normal thyroid function with a nontoxic goiter. Some possible causes of nontoxic goiter include:

Risk Factors

Nontoxic goiter is more common in women and in people over age 40.
The following factors increase your chance of developing nontoxic goiter:

Symptoms

Nontoxic goiters usually do not have noticeable symptoms, unless they become very large. Symptoms may include:

Diagnosis

You will be asked about your symptoms and medical history. A physical exam will be done. Your doctor may recommend a specialist. An endocrinologist focuses on hormone related issues.
Your body fluids and tissues may be tested. This can be done with:
Images may be taken of your body structures. This can be done with:

Treatment

Nontoxic goiters usually grow very slowly. They may not cause any symptoms. In this case, they do not need treatment.
Treatment may be needed if the goiter grows rapidly, affects your neck, or obstructs your breathing.
If a nontoxic goiter progresses to the nodular stage, and the nodule is found to be cancerous, you will need treatment. Talk with your doctor about the best plan for you. Treatment options include the following:

Hormone Suppression Therapy

Thyroid hormone medication is used to suppress secretion of thyrotropin (TSH). TSH is the thyroid-stimulating hormone that causes growth. This therapy is most effective for early stage goiters that have grown due to impaired hormone production. It is less effective for goiters that have progressed to the nodular stage.

Radioactive Iodine

Radioactive iodine treatment is used to reduce the size of large goiter. It is used in the elderly when surgical treatment is not an option.

Thyroidectomy

A surgery to remove a portion or all of the thyroid gland. It is the treatment of choice if the goiter is so large to cause difficulty in breathing or swallowing.

Prevention

Be sure that your diet contains enough iodine.

RESOURCES

The American Thyroid Association http://www.thyroid.org

The Hormone Foundation http://www.hormone.org

CANADIAN RESOURCES

The College of Family Physicians of Canada http://www.cfpc.ca

Thyroid Foundation of Canada http://www.thyroid.ca

References

Bonnema SJ, Bennedbek FN, et al. Management of the nontoxic multinodular goiter: a North American Survey. J Clin Endocrinol Metab. 2002;87:112-117.

Bonnema SJ, Nielsen VE, et al. Improvement of goiter volume reduction after 0.3 mg recombinant human thyrotropin-stimulated radioiodine therapy in patients with a very large goiter: a double-blinded, randomized trail. J Clin Endo Metab. 2007;92:3424-3428.

Diehl LA, Garcia V, Bonnema SJ, et al. Management of the nontoxic multinodular goiter in Latin America: comparison with North America and Europe, an electronic survey. J Clin Endocrinol Metab. 2005;90:117-123.

Freitas JE. Therapeutic options in the management of toxic and nontoxic nodular goiter. Seminars in Nuclear Medicine. 2000;30:88-97.

Hurley DL, Gharib H. Evaluation and management of multinodular goiter. Otolaryngol Clin North Am. 1996;29:527-540.

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