eMedicine Specialties > Endocrinology > Thyroid

Goiter, Nontoxic: Follow-up

Author: Stephanie L Lee, MD, PhD, Fellow, Association of Clinical Endocrinology; Director of Thyroid Nodule and Cancer Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Associate Professor, Department of Medicine, Boston University School of Medicine
Coauthor(s): Sonia Ananthakrishnan, MD, Attending Physician, Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center
Contributor Information and Disclosures

Updated: May 5, 2009

Follow-up

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.

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.

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).

Complications

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

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.

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.

Miscellaneous

Medicolegal Pitfalls

  • Because of the difficulty in detecting nodules, close surveillance is necessary to ensure that no nodule is truly present. This may require ultrasonographic examination.
  • Growth of a previously stable goiter or onset of clinical symptoms, such as development of a hoarse voice with vocal cord paralysis, should be evaluated expeditiously for malignant transformation.
  • Remember the limitations of thyroid thin-needle aspiration in evaluating nodular thyroid disease. If the nodule is large, be concerned about sample bias. An adequate number of thyroid cells should be present for a full evaluation. A cyst represents a dilemma, because often only inflammatory cells are observed. Additional procedures may be necessary to determine the true nature of the condition and rule out thyroid cancer.
  • Antithyroid antibodies can be positive in as many as 10% of nontoxic goiters in the absence of thyroiditis.
 


More on Goiter, Nontoxic

Overview: Goiter, Nontoxic
Differential Diagnoses & Workup: Goiter, Nontoxic
Treatment & Medication: Goiter, Nontoxic
Follow-up: Goiter, Nontoxic
Multimedia: Goiter, Nontoxic
References
Further Reading
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References

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  2. Agarwal G, Aggarwal V. Is total thyroidectomy the surgical procedure of choice for benign multinodular goiter? An evidence-based review. World J Surg. Jul 2008;32(7):1313-24. [Medline].

  3. Weetman AP. Radioiodine treatment for benign thyroid diseases. Clin Endocrinol (Oxf). Jun 2007;66(6):757-64. [Medline].

  4. Baczyk M, Pisarek M, Czepczynski R, Ziemnicka K, Gryczynska M, Pietz L, et al. Therapy of large multinodular goitre using repeated doses of radioiodine. Nucl Med Commun. Mar 2009;30(3):226-31. [Medline].

  5. Duntas LH, Cooper DS. Review on the occasion of a decade of recombinant human TSH: prospects and novel uses. Thyroid. May 2008;18(5):509-16. [Medline].

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Keywords

nontoxic goiter, thyroid, goiter, TSH, hypothyroid, hypothyroidism, thyroid symptoms, thyroid disease, thyroid problems, thyroid hormone, thyroxine, thyroid levels, thyroid treatment, thyroid function, thyroid medication, TSH levels, TSH T4, enlarged thyroid, thyroid stimulating hormone, thyroid-stimulating hormone, thyroid hormones, thyroid TSH, T3 thyroid, multinodular goiter, triiodothyronine, thyroidectomy, iodine deficiency, adenomatous goiter, endemic goiter, sporadic goiter, nodular hyperplasia, follicular epithelial hyperplasia, cretinism,dyshormonogenesis, diffuse or nodular enlargement of the thyroid gland, diffuse goiter

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Contributor Information and Disclosures

Author

Stephanie L Lee, MD, PhD, Fellow, Association of Clinical Endocrinology; Director of Thyroid Nodule and Cancer Center, Associate Chief, Section of Endocrinology, Diabetes and Nutrition, Boston Medical Center; Associate Professor, Department of Medicine, Boston University School of Medicine
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, Attending Physician, Department of Medicine, Section of Endocrinology, Diabetes and Nutrition, Boston University School of Medicine/Boston Medical Center
Disclosure: Nothing to disclose.

Medical Editor

Steven R Gambert, MD, MACP, Chairman, Department of Medicine, Physician-in-Chief, Sinai Hospital of Baltimore; Professor of Medicine, Program Director, Internal Medicine Program, Johns Hopkins University School of Medicine
Steven R Gambert, MD, MACP 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.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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.

CME Editor

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.

 
 
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