Nontoxic Goiter Follow-up

  • Author: Stephanie L Lee, MD, PhD; Chief Editor: George T Griffing, MD   more...
 
Updated: Sep 14, 2011
 

Further Outpatient Care

  • The patient with a large goiter and no obstructive symptoms can be monitored in an outpatient setting. Conduct a physical examination every 6 months to determine if obstructive symptoms have developed or worsened and to perform thyroid function tests (ie, TSH, free T4).
  • Depending on iodine intake in the diet, some of these patients develop thyroid autonomy and thyrotoxicosis.
  • Often, thyroid imaging is not necessary when the patient is examined by an endocrinologist experienced in thyroid examinations. The method of choice is ultrasonography unless the goiter extends into the thoracic inlet.
  • Routine nuclear scintigraphy is not necessary.
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Transfer

  • Transfer may be required in patients with significant tracheomalacia who require surgery. Long-term compression of the trachea by a nontoxic goiter causes tracheal cartilage to lose its strength. This can be life threatening, and tracheal intubation or tracheotomy may be required.
  • Additionally, if a goiter extends significantly into the thorax, a thoracic surgeon may be needed to open the chest wall to fully excise the goiter.
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Deterrence/Prevention

  • Prevention of endemic goiter may be accomplished by iodine supplementation, using iodine supplements in drinking water sources or iodized oil on bread (strategies that can be applied to a whole country).
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Complications

  • Complications of a nontoxic goiter occur because of growth and compression of neck structures or the development of areas of autonomy and thyrotoxicosis.[17]
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Prognosis

  • Prognosis is good.
  • Usually, nontoxic goiters grow very slowly over many years. Any rapid growth behavior must be evaluated for either degeneration or hemorrhage of a nodule or for growth of a neoplasm.
  • Often, in patients who present with progressive goiter growth, those with significant dysphagia or dyspnea must be evaluated for subtotal thyroidectomy.
  • In some patients, radioactive iodine therapy can be considered, especially if the patient is older.
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Patient Education

  • Thyroid self-examination may be taught to patients, allowing them to monitor their own body for early changes in gland size.
  • For excellent patient education resources, visit eMedicine's Endocrine System Center. Also, see eMedicine's patient education article Thyroid Problems.
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Contributor Information and Disclosures
Author

Stephanie L Lee, MD, PhD  Associate Professor, Department of Medicine, Boston University School of Medicine; Director of Thyroid Health Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Fellow, Association of Clinical Endocrinology

Stephanie L Lee, MD, PhD is a member of the following medical societies: American College of Endocrinology, American Thyroid Association, and Endocrine Society

Disclosure: Nothing to disclose.

Coauthor(s)

Sonia Ananthakrishnan, MD  Assistant Professor of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine, Boston Medical Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Steven R Gambert, MD  Professor of Medicine, Johns Hopkins University School of Medicine; Director of Geriatric Medicine, University of Maryland Medical Center and R. Adams Cowley Shock Trauma Center

Steven R Gambert, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American Geriatrics Society, Association of Professors of Medicine, Endocrine Society, and Gerontological Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Kent Wehmeier, MD  Professor, Department of Internal Medicine, Division of Endocrinology, Diabetes, and Metabolism, St Louis University School of Medicine

Kent Wehmeier, MD is a member of the following medical societies: American Society of Hypertension, Endocrine Society, and International Society for Clinical Densitometry

Disclosure: Nothing to disclose.

Mark Cooper, MBBS, PhD, FRACP  Head, Diabetes & Metabolism Division, Baker Heart Research Institute, Professor of Medicine, Monash University

Disclosure: Nothing to disclose.

Chief Editor

George T Griffing, MD  Professor of Medicine, St Louis University School of Medicine

George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Medical Practice Executives, American College of Physician Executives, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical Research, Endocrine Society, International Society for Clinical Densitometry, and Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

References

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Intrathoracic goiter causing obstruction. This patient has a visible goiter on physical examination. In addition, he has distension of his left external jugular vein, facial erythema (when compared with his shoulder), and cutaneous varicosities of venous blood draining from his head into his chest because of jugular obstruction from his goiter.
Technetium-99m (99mTc) thyroid scan of a large, nontoxic multinodular goiter. Multiple cold and hot nodules are observed in the enlarged thyroid gland. The white arrow indicates sternal notch marker.
Areas of autonomy with excess thyroid hormone secretion in a large nodular goiter. This technetium-99m (99mTc) thyroid scan shows hot and cold nodules in a multinodular goiter. Although the patient's thyroid-stimulating hormone level had become progressively suppressed, it was within the reference range, at 0.4 mU/mL (reference range 0.35-5.5 mU/mL).
Nontoxic goiter of the thyroid gland with tracheal compression. An axial, noncontrast computed tomography scan through the thyroid shows significant tracheal compression.
Relief of tracheal compression after subtotal thyroidectomy of large, obstructive, nontoxic multinodular goiter. (A) Laryngoscopy demonstrating critical tracheal narrowing before thyroidectomy; (B) laryngoscopy showing widened patent trachea after thyroidectomy.
Multinodular goiter. On visual inspection of the neck (image on left), this patient appears to have a goiter. The computed tomography scan (image on right) shows the asymmetrical goiter, measuring 9.3 x 7.4 cm, with tracheal deviation, although no tracheal obstruction is present.
 
 
 
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