Nontoxic Goiter Follow-up

Updated: Dec 12, 2016
  • Author: Stephanie L Lee, MD, PhD; Chief Editor: George T Griffing, MD  more...
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Follow-up

Further Outpatient Care

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  • 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

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  • 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

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  • 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

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  • Complications of a nontoxic goiter occur because of growth and compression of neck structures or the development of areas of autonomy and thyrotoxicosis. [19]
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Prognosis

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  • 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.
  • A study by Cramon et al found that both disease-specific and generic health-related quality of life discrepancies continued six months after treatment in benign nontoxic goiter patients. [20]
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Patient Education

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  • 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 eMedicineHealth's Thyroid and Metabolism Center. Also, see eMedicineHealth's patient education article Thyroid Problems.
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