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Nontoxic Nodular Goiter
(Sporadic Goiter; Simple Goiter; Nodular Enlargement of the Thyroid Gland)
- Diffuse—enlarging the whole thyroid gland
- Nodular—enlargement caused by nodules, or lumps, on the thyroid
|Goiter (Enlargement of the Thyroid Gland)|
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- Heredity (family history of goiters)
- Regular use of medications such as lithium, propylthiouracil, phenylbutazone, or aminoglutethimide
- Taking a lot of substances (goitrogens) that inhibit production of thyroid hormone—common goitrogens include foods such as cabbage, turnips, brussel sprouts, seaweed, and millet
- Iodine deficiency—Iodine deficiency is very rare in the United States and other developed countries, due to the use of iodized table salt; this is a primary cause of goiter in other parts of the world, particularly in mountainous areas, or areas that experience heavy rainfall or flooding
- Sex: female (nontoxic goiter is more common in women than men)
- Age: over 40 years
- A diet low in iodine
- Family history of goiter
- History of radiation therapy to head or neck, especially during childhood
- Swelling on the neck
- Breathing difficulties, coughing, or wheezing with large goiter
- Difficulty swallowing with large goiter
- Feeling of pressure on the neck
- Examination of the neck—to assess any thyroid enlargement
- Ultrasound —a test that uses sound waves to identify nodules of the neck and thyroid
- Blood tests—to assess levels of thyroid hormones (eg, thyroid stimulating hormone); thyroid autoantibodies tests may also be done
- Thyroid scan (scintigraphy)—a picture of your thyroid gland taken after you have been given a shot or drink of a radioisotope to show how your thyroid is functioning and exclude thyroid cancer
- Fine needle aspiration biopsy —a tissue sample is taken with a small needle to determine if it is benign or malignant (cancer)
- Barium swallow —a test to determine if the enlarged goiter is compressing the esophagus, thus causing swallowing difficulty
- X-ray of neck and chest for large goiters—to see if the trachea is compressed
Hormone Suppression Therapy
American Association of Clinical Endocrinologists http://www.aace.com
The American Thyroid Association http://www.thyroid.org
The Hormone Foundation http://www.hormone.org
Thyroid Foundation of America http://www.tsh.org
Canadian Family Physician http://www.cfpc.ca
Thyroid Foundation of Canada http://www.thyroid.ca
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.
Kasper DL, et al. Harrison’s Principles of Internal Medicine . 16th ed. New York, NY: McGraw-Hill; 2005.
- Reviewer: Kim Carmichael, MD
- Review Date: 12/2013
- Update Date: 01/13/2014