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Nontoxic Goiter


Presentation

  • We present a rare case of a giant substernal nontoxic goiter which caused acute respiratory failure which was treated by urgent thyroidectomy through a T-incision.[ncbi.nlm.nih.gov]
  • Nodules are clonal or polyclonal and are due to heterogeneous responses of follicular epithelium to TSH Exophthalmos of Graves disease is not present Also called nodular hyperplasia Nontoxic goiter : no hyperthyroidism present Epidemiology 90% of those[pathologyoutlines.com]
Goiter
  • The disappearance curves of Tg in both groups had two exponentials, an initial steep slope with a half-life of 4.0 /- 1.8 (SD) h in nontoxic goiter and 4.5 /- 3.2 h in toxic goiter.[ncbi.nlm.nih.gov]
Laboratory Technician
  • . § Laboratory technician, Radioactivity Research Center, University of California Medical Center.[nejm.org]
Inspiratory Stridor
  • Patients who have symptoms and signs of tracheal compression (inspiratory stridor and dyspnea) should have radiographs taken of the trachea or CT or MR imaging of the neck and upper thorax.[journals.lww.com]
Muscle Tenderness
  • The changes do not seem to cause more neck pain, muscle tenderness or degeneration of the cervical spine.[ncbi.nlm.nih.gov]
Neck Swelling
  • Symptomatic patient may present with painless neck swelling, cosmetic complaints, shortness of breath, sudden increase in goiter size with pain due to hemorrhage, larger goiter causing obstructive signs eg dysphagia, choking sensation and Pemberton's[specialty.mims.com]
  • Grade 0: no goiter is found (the thyroid impalpable and not visible on clinical inspection); grade 1: neck thickening is present from enlarged thyroid and palpable, however, not visible in normal position of neck; grade 2: neck swelling, visible when[endocrinefacts.org]

Workup

  • Workup for a thyroid nodule includes a careful neck exam followed by a thyroid panel (TSH, T3, T4).[surgery4children.com]

Treatment

  • However, both disease-specific and generic HRQoL deficits persisted six months after treatment.[ncbi.nlm.nih.gov]

Prognosis

  • […] but may be seen incidentally CT may be useful for fully characterizing the extent of substernal (retrosternal) goiter an enlarged and heterogeneous thyroid gland suggests the diagnosis, which is confirmed by ultrasound or scintigraphy Treatment and prognosis[radiopaedia.org]

Etiology

  • Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology.[icd10coded.com]
  • Etiology is usually unknown. Some known causes include iodine deficiency, iodine excess, goitrogen ingestion, autoimmune disorders, thyroid hormone production defects and certain medications. It is usually asymptomatic.[specialty.mims.com]
  • However, the true etiology of most nontoxic goiters in iodine-sufficient areas is unknown.[msdmanuals.com]
  • Goitrous enlargement may result from various etiologies: stimulation from elevated TSH levels as seen in iodine deficiency and Hashimoto disease, TSH-receptor antibodies/agonists as in Graves disease, or unclear etiology such as in nontoxic multinodular[ime.acponline.org]
  • In the US, however, Hashimoto's and Graves' disease are more common etiologies. Goiters can be classified based on their morphology, function, or dignity (benign or malignant). Symptoms depend on etiology and are often absent.[amboss.com]

Epidemiology

  • Race No convincing epidemiologic studies suggest that race plays an important role in the development of nontoxic goiter.[emedicine.medscape.com]
  • Epidemiology References: [1] Epidemiological data refers to the US, unless otherwise specified.[amboss.com]
  • […] dominant nodule is present Nodules are clonal or polyclonal and are due to heterogeneous responses of follicular epithelium to TSH Exophthalmos of Graves disease is not present Also called nodular hyperplasia Nontoxic goiter : no hyperthyroidism present Epidemiology[pathologyoutlines.com]
  • The results of two large epidemiological studies illustrating these differences are summarized in Table 7. Table 7. Incidence and prevalence of palpable thyroid nodules by sex.[endocrinefacts.org]
Sex distribution
Age distribution

Pathophysiology

  • Long-term studies are needed to define the effects of thyroid hormone suppressive therapy on the growth of goitrous lesions based on their underlying pathophysiology.[ncbi.nlm.nih.gov]

Prevention

  • Some, but not all, series suggest that postoperative use of thyroid hormone suppressive therapy prevents recurrence of benign goiter.[ncbi.nlm.nih.gov]
  • Table salt has been supplemented in the United States since the 1920s for the prevention of cretinism and endemic goiter.[emedicine.medscape.com]
  • Compensatory small elevations in thyroid-stimulating hormone (TSH) occur, preventing hypothyroidism, but the TSH stimulation results in goiter formation. Recurrent cycles of stimulation and involution may result in nontoxic nodular goiters.[msdmanuals.com]

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