Materiały źródłowe

• #1 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  A goiter is often discovered during a routine physical exam. By touching your neck, your health care provider may detect an enlargement of the thyroid, an individual nodule or multiple nodules. Sometimes a goiter is found when you are undergoing an imaging test for another condition. […] Additional tests are then ordered to do the following: Measure the size of the thyroid. Detect any nodules. Assess whether the thyroid may be overactive or underactive. Determine the cause of the goiter. […] Tests may include: Thyroid function tests. A blood sample can be used to measure the amount of Thyroid-stimulating Hormone (TSH) produced by the pituitary gland and how much Thyroxine (T-4) and Triiodothyronine (T-3) is produced by the thyroid. These tests can show whether the goiter is associated with an increase or decrease in thyroid function.

• #2 Goiter | American Thyroid Association

  https://www.thyroid.org/goiter/

  WHAT ARE THE SYMPTOMS OF A GOITER? The term goiter simply refers to the abnormal enlargement of the thyroid gland. A goiter indicates there is a condition present which is causing the thyroid to grow abnormally. […] HOW DO YOU DIAGNOSE A GOITER? As mentioned earlier, the diagnosis of a goiter is usually made at the time of a physical examination when an enlargement of the thyroid is found. However, the presence of a goiter indicates there is an abnormality of the thyroid gland. Therefore, it is important to determine the cause of the goiter. […] If you are hypothyroid, you may have Hashimotos Thyroiditis and you may get additional blood tests to confirm this diagnosis. Other tests used to help diagnose the cause of the goiter may include a radioactive iodine scan, thyroid ultrasound, or a fine needle aspiration biopsy.

• #3 Pruebas para diagnosticar el Bocio | PortalCLÍNIC

  https://www.clinicbarcelona.org/en/assistance/diseases/goitre/diagnosis

  The presence of goitre indicates impaired function of the thyroid gland, so it is important to diagnose the cause of the goitre. […] The main tests are: Blood tests. To determine whether the thyroid is functioning properly. […] Cervical ultrasound. To measure the size of the thyroid and detect the presence of nodules. If the thyroid is diffusely enlarged and the blood test shows hyperthyroidism (increased thyroid hormones), this will be supplemented with autoimmunity tests to help diagnose the disease. If the thyroid secretes too little hormone (hypothyroidism) it is more likely to be Hashimoto’s thyroiditis or a multinodular goitre. […] Other tests such as a cervical fine needle aspiration (FNA) or a cervical scan with radioactive iodine may be necessary to complete the diagnosis.

• #4 Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/12625-goiter

  Goiter may be associated with an irregular amount of thyroid hormone in your body (hyperthyroidism or hypothyroidism) or with normal levels of thyroid hormone (euthyroid). […] Your healthcare provider usually diagnoses goiter when they perform a physical examination and feel that you have an enlarged thyroid. However, the presence of a goiter indicates that theres an issue with your thyroid gland. Theyll need to figure out what the issue is. […] Your provider can use several tests to diagnose and evaluate goiter, including the following: Physical exam: Your provider may be able to tell if your thyroid gland is enlarged by feeling your neck area for nodules and signs of tenderness. […] A biopsy is the removal of a sample of tissue or cells to be studied in a laboratory. You may need a thyroid biopsy if there are large nodules in your thyroid gland. A biopsy is taken to rule out cancer.

• #5 Goiter – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562161/

  Patients with goiter can be euthyroid, hypothyroid, or hyperthyroid. The vast majority of the patients with simple goiter (diffuse enlargement of thyroid without any nodules) are euthyroid. […] Most of the time, goiters are found during a physical examination or can be an incidental finding on imaging such as carotid Doppler, neck CT, cervical MRI, or PET-CT. […] The aim of goiter treatment is to relieve compression and to restore euthyroidism. […] Monitoring and observation are recommended initially if there are no compressive symptoms, as certain goiters can spontaneously regress with time. […] In patients with toxic goiters, treatment options include surgery, radioiodine therapy, or antithyroid drugs. […] Simple goiter has good prognosis. If thyroid continues to enlarge it may compress the surrounding structures and may cause difficulty in breathing, difficulty in swallowing, and hoarseness.

• #6 Goiter – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562161/

  Patients with goiter commonly present to outpatient facilities with a variety of complaints. Goiter encompasses many different causes and morbidities, and accurate diagnosis is essential for the proper treatment approach. […] Goiter means enlargement of the thyroid gland and is a general term that conveys the information that the volume of the thyroid gland is larger than normal. The presence of goiter can be determined by inspection, palpation, or by an imaging study. […] The most common cause of goiters worldwide is iodine deficiency that affects an estimated 2.2 billion people. […] Enlargement of thyroid, i.e. goiter is an adaptive reaction of thyroid follicular cells to any process that blocks thyroid hormone production. […] Thyroid hormonal function and the growth rate of the thyroid gland reflect the clinical presentation of a goiter.

• #7 Goiter – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK562161/

  Patients with goiter commonly present to outpatient facilities with a variety of complaints. Goiter encompasses many different causes and morbidities, and accurate diagnosis is essential for the proper treatment approach. […] Goiter means enlargement of the thyroid gland and is a general term that conveys the information that the volume of the thyroid gland is larger than normal. The presence of goiter can be determined by inspection, palpation, or by an imaging study. […] The most common cause of goiters worldwide is iodine deficiency that affects an estimated 2.2 billion people. […] Enlargement of thyroid, i.e. goiter is an adaptive reaction of thyroid follicular cells to any process that blocks thyroid hormone production. […] Thyroid hormonal function and the growth rate of the thyroid gland reflect the clinical presentation of a goiter.

• #8 Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/12625-goiter

  Goiter may be associated with an irregular amount of thyroid hormone in your body (hyperthyroidism or hypothyroidism) or with normal levels of thyroid hormone (euthyroid). […] Your healthcare provider usually diagnoses goiter when they perform a physical examination and feel that you have an enlarged thyroid. However, the presence of a goiter indicates that theres an issue with your thyroid gland. Theyll need to figure out what the issue is. […] Your provider can use several tests to diagnose and evaluate goiter, including the following: Physical exam: Your provider may be able to tell if your thyroid gland is enlarged by feeling your neck area for nodules and signs of tenderness. […] A biopsy is the removal of a sample of tissue or cells to be studied in a laboratory. You may need a thyroid biopsy if there are large nodules in your thyroid gland. A biopsy is taken to rule out cancer.

• #9 Differential Dx – Thyroid Exam – Physical Diagnosis Skills – University of Washington School of Medicine

  https://depts.washington.edu/physdx/thyroid/diffdx.html

  Goiter: false positive […] Not all patients you think have a large thyroid actually do. […] Overestimation of the size of the thyroid can result from: […] […] Goiter: false negative […] On some patients, you may miss detecting an enlarged thyroid. […] Underestimation of the size of the thyroid can result from: […]

• #10 Thyroid Exam | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/thyroid.html

  The thyroid exam is important as its often the first step towards diagnosing thyroid diseases such as Graves disease, Hashimotos thyroiditis and multinodular goiters. […] Assess for asymmetrical elevation of lobes (suggests nodularity). […] Diffuse Enlargement: isthmus and lateral lobes, no nodules. Graves disease, Hashimotos thyroiditis, endemic goiter. […] Single node: Cyst, benign tumor, false positive (only one nodule of multinodular goiter detected). Elevates index of suspicion for malignancy. […] Multinodular Goiter (iodine deficiency). […] Soft in Graves Disease and may have bruit. […] Firm in Hashimotos thyroiditis, malignancy, benign and malignant nodules. […] Tender in thyroiditis. […] Systolic or continuous bruit may be heard over lateral lobes in hyperthyroidism.

• #11 Thyroid Exam | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/thyroid.html

  The thyroid exam is important as its often the first step towards diagnosing thyroid diseases such as Graves disease, Hashimotos thyroiditis and multinodular goiters. […] Assess for asymmetrical elevation of lobes (suggests nodularity). […] Diffuse Enlargement: isthmus and lateral lobes, no nodules. Graves disease, Hashimotos thyroiditis, endemic goiter. […] Single node: Cyst, benign tumor, false positive (only one nodule of multinodular goiter detected). Elevates index of suspicion for malignancy. […] Multinodular Goiter (iodine deficiency). […] Soft in Graves Disease and may have bruit. […] Firm in Hashimotos thyroiditis, malignancy, benign and malignant nodules. […] Tender in thyroiditis. […] Systolic or continuous bruit may be heard over lateral lobes in hyperthyroidism.

• #12 Thyroid Exam | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/thyroid.html

  The thyroid exam is important as its often the first step towards diagnosing thyroid diseases such as Graves disease, Hashimotos thyroiditis and multinodular goiters. […] Assess for asymmetrical elevation of lobes (suggests nodularity). […] Diffuse Enlargement: isthmus and lateral lobes, no nodules. Graves disease, Hashimotos thyroiditis, endemic goiter. […] Single node: Cyst, benign tumor, false positive (only one nodule of multinodular goiter detected). Elevates index of suspicion for malignancy. […] Multinodular Goiter (iodine deficiency). […] Soft in Graves Disease and may have bruit. […] Firm in Hashimotos thyroiditis, malignancy, benign and malignant nodules. […] Tender in thyroiditis. […] Systolic or continuous bruit may be heard over lateral lobes in hyperthyroidism.

• #13 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  If a multinodular goiter is found or suspected, a thorough history and physical exam should be performed. Important history includes how fast the thyroid is growing, risk factors for thyroid cancer (i.e. family history of cancer and history of radiation therapy to the neck or chest), family history of goiter, hoarseness, and symptoms of hyperthyroidism. Important physical exam findings include a goiter that can be felt, growth down into the chest, and enlarged neck veins. […] After a complete history and physical exam, a thyroid ultrasound (USG) should be done. There is no radiation associated with an USG. An USG is the best test to look at the thyroid and will allow the doctor to see the size of the thyroid and specific features of the nodule(s) including: size, number of nodules, if there are calcifications (calcium deposits), echotexture (i.e. how bright or dark it looks on USG), borders, shape, and if it is solid or cystic (i.e. fluid-filled).

• #14 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  If a multinodular goiter is found or suspected, a thorough history and physical exam should be performed. Important history includes how fast the thyroid is growing, risk factors for thyroid cancer (i.e. family history of cancer and history of radiation therapy to the neck or chest), family history of goiter, hoarseness, and symptoms of hyperthyroidism. Important physical exam findings include a goiter that can be felt, growth down into the chest, and enlarged neck veins. […] After a complete history and physical exam, a thyroid ultrasound (USG) should be done. There is no radiation associated with an USG. An USG is the best test to look at the thyroid and will allow the doctor to see the size of the thyroid and specific features of the nodule(s) including: size, number of nodules, if there are calcifications (calcium deposits), echotexture (i.e. how bright or dark it looks on USG), borders, shape, and if it is solid or cystic (i.e. fluid-filled).

• #15 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  A goiter is often discovered during a routine physical exam. By touching your neck, your health care provider may detect an enlargement of the thyroid, an individual nodule or multiple nodules. Sometimes a goiter is found when you are undergoing an imaging test for another condition. […] Additional tests are then ordered to do the following: Measure the size of the thyroid. Detect any nodules. Assess whether the thyroid may be overactive or underactive. Determine the cause of the goiter. […] Tests may include: Thyroid function tests. A blood sample can be used to measure the amount of Thyroid-stimulating Hormone (TSH) produced by the pituitary gland and how much Thyroxine (T-4) and Triiodothyronine (T-3) is produced by the thyroid. These tests can show whether the goiter is associated with an increase or decrease in thyroid function.

• #16 Goitre Causes, investigation and management

  https://www.racgp.org.au/afp/2012/august/goitre

  Goitre refers to an enlarged thyroid. […] Thyroid stimulating hormone is the appropriate first test for all patients with goitre; if this hormone is low a radionuclide scan is helpful. […] Thyroid ultrasound has become an extension of physical examination and should be performed in all patients with goitre. […] Patients with goitre or thyroid nodules should have a serum thyroid stimulating hormone (TSH) to determine the current functional status of the thyroid. […] If the TSH is abnormal, a free T4 and free T3 should also be checked. […] Thyroid ultrasound should be performed in all patients with known or suspected thyroid nodules. […] A radionuclide thyroid scan is indicated in patients with a subnormal TSH to determine the functional status of any nodules within the thyroid and the underlying cause of clinical or subclinical hyperthyroidism.

• #17 Goiter Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/120034-workup

  Initial screening should include TSH. Given the sensitive third-generation assays, in the absence of symptoms of hyperthyroidism or hypothyroidism, further testing is not required. An assessment of free thyroxine index or direct measurement of free thyroxine would be the next step in the evaluation. […] Further laboratory testing is based on presentation and results of screening studies and may include thyroid antibodies (antithyroid peroxidase; formerly, the antimicrosomal antibodies and antithyroglobulin), thyroglobulin, sedimentation rate, and calcitonin in an individual at high risk for medullary carcinoma of the thyroid. […] Fine-needle aspiration biopsy is used for cytologic diagnosis. Fine-needle aspiration of the thyroid is used to determine the cause of an enlarged gland. In general, the procedure is not used in the workup of autonomously functioning nodules. The procedure has little morbidity and can be tailored to the situation.

• #18 Goitre Causes, investigation and management

  https://www.racgp.org.au/afp/2012/august/goitre

  Goitre refers to an enlarged thyroid. […] Thyroid stimulating hormone is the appropriate first test for all patients with goitre; if this hormone is low a radionuclide scan is helpful. […] Thyroid ultrasound has become an extension of physical examination and should be performed in all patients with goitre. […] Patients with goitre or thyroid nodules should have a serum thyroid stimulating hormone (TSH) to determine the current functional status of the thyroid. […] If the TSH is abnormal, a free T4 and free T3 should also be checked. […] Thyroid ultrasound should be performed in all patients with known or suspected thyroid nodules. […] A radionuclide thyroid scan is indicated in patients with a subnormal TSH to determine the functional status of any nodules within the thyroid and the underlying cause of clinical or subclinical hyperthyroidism.

• #19 Goiter: Practice Essentials, Pathophysiology, Epidemiology

  https://emedicine.medscape.com/article/120034-overview

  A goiter is an enlarged thyroid gland, and it may be diffuse or nodular. […] Initial screening for goiters should include thyroid-stimulating hormone (TSH). […] Diagnosis of goiters: Initial screening should include TSH. Given the sensitive third-generation assays, in the absence of symptoms of hyperthyroidism or hypothyroidism, further testing is not required. An assessment of free thyroxine index or direct measurement of free thyroxine would be the next step in the evaluation. […] Further laboratory testing is based on presentation and results of screening studies and may include thyroid antibodies (antithyroid peroxidase; formerly, the antimicrosomal antibodies and antithyroglobulin), thyroglobulin, sedimentation rate, and calcitonin in an individual at high risk for medullary carcinoma of the thyroid. […] Ultrasonography can be used to establish and follow goiter size, consistency, and nodularity. […] Fine-needle aspiration biopsy is employed for cytologic diagnosis. […] Core biopsy, or large-needle biopsy, of the thyroid uses a larger-gauge needle, providing a fragment of tissue.

• #20 Goitre Causes, investigation and management

  https://www.racgp.org.au/afp/2012/august/goitre

  Goitre refers to an enlarged thyroid. […] Thyroid stimulating hormone is the appropriate first test for all patients with goitre; if this hormone is low a radionuclide scan is helpful. […] Thyroid ultrasound has become an extension of physical examination and should be performed in all patients with goitre. […] Patients with goitre or thyroid nodules should have a serum thyroid stimulating hormone (TSH) to determine the current functional status of the thyroid. […] If the TSH is abnormal, a free T4 and free T3 should also be checked. […] Thyroid ultrasound should be performed in all patients with known or suspected thyroid nodules. […] A radionuclide thyroid scan is indicated in patients with a subnormal TSH to determine the functional status of any nodules within the thyroid and the underlying cause of clinical or subclinical hyperthyroidism.

• #21 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  A goiter is often discovered during a routine physical exam. By touching your neck, your health care provider may detect an enlargement of the thyroid, an individual nodule or multiple nodules. Sometimes a goiter is found when you are undergoing an imaging test for another condition. […] Additional tests are then ordered to do the following: Measure the size of the thyroid. Detect any nodules. Assess whether the thyroid may be overactive or underactive. Determine the cause of the goiter. […] Tests may include: Thyroid function tests. A blood sample can be used to measure the amount of Thyroid-stimulating Hormone (TSH) produced by the pituitary gland and how much Thyroxine (T-4) and Triiodothyronine (T-3) is produced by the thyroid. These tests can show whether the goiter is associated with an increase or decrease in thyroid function.

• #22 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  Antibody test. Depending on the results of the thyroid function test, your health care provider may order a blood test to detect an antibody linked to an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease. […] Ultrasonography. Ultrasonography uses sound waves to create a computerized image of tissues in your neck. The technician uses a wand-like device (transducer) over your neck to do the test. This imaging technique can reveal the size of your thyroid gland and detect nodules. […] Radioactive iodine uptake. If your health care provider orders this test, you are given a small amount of radioactive iodine. Using a special scanning device, a technician can measure the amount and rate at which your thyroid takes it in. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern. The results may help determine function and cause of the goiter. […] Biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a very small needle into your thyroid to obtain a tissue or fluid sample from nodules. The samples are tested for the presence of cancerous cells.

• #23 Goiter Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/120034-workup

  Initial screening should include TSH. Given the sensitive third-generation assays, in the absence of symptoms of hyperthyroidism or hypothyroidism, further testing is not required. An assessment of free thyroxine index or direct measurement of free thyroxine would be the next step in the evaluation. […] Further laboratory testing is based on presentation and results of screening studies and may include thyroid antibodies (antithyroid peroxidase; formerly, the antimicrosomal antibodies and antithyroglobulin), thyroglobulin, sedimentation rate, and calcitonin in an individual at high risk for medullary carcinoma of the thyroid. […] Fine-needle aspiration biopsy is used for cytologic diagnosis. Fine-needle aspiration of the thyroid is used to determine the cause of an enlarged gland. In general, the procedure is not used in the workup of autonomously functioning nodules. The procedure has little morbidity and can be tailored to the situation.

• #24 Goiter Workup: Laboratory Studies, Imaging Studies, Procedures

  https://emedicine.medscape.com/article/120034-workup

  Initial screening should include TSH. Given the sensitive third-generation assays, in the absence of symptoms of hyperthyroidism or hypothyroidism, further testing is not required. An assessment of free thyroxine index or direct measurement of free thyroxine would be the next step in the evaluation. […] Further laboratory testing is based on presentation and results of screening studies and may include thyroid antibodies (antithyroid peroxidase; formerly, the antimicrosomal antibodies and antithyroglobulin), thyroglobulin, sedimentation rate, and calcitonin in an individual at high risk for medullary carcinoma of the thyroid. […] Fine-needle aspiration biopsy is used for cytologic diagnosis. Fine-needle aspiration of the thyroid is used to determine the cause of an enlarged gland. In general, the procedure is not used in the workup of autonomously functioning nodules. The procedure has little morbidity and can be tailored to the situation.

• #25 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  Antibody test. Depending on the results of the thyroid function test, your health care provider may order a blood test to detect an antibody linked to an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease. […] Ultrasonography. Ultrasonography uses sound waves to create a computerized image of tissues in your neck. The technician uses a wand-like device (transducer) over your neck to do the test. This imaging technique can reveal the size of your thyroid gland and detect nodules. […] Radioactive iodine uptake. If your health care provider orders this test, you are given a small amount of radioactive iodine. Using a special scanning device, a technician can measure the amount and rate at which your thyroid takes it in. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern. The results may help determine function and cause of the goiter. […] Biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a very small needle into your thyroid to obtain a tissue or fluid sample from nodules. The samples are tested for the presence of cancerous cells.

• #26 Pruebas para diagnosticar el Bocio | PortalCLÍNIC

  https://www.clinicbarcelona.org/en/assistance/diseases/goitre/diagnosis

  The presence of goitre indicates impaired function of the thyroid gland, so it is important to diagnose the cause of the goitre. […] The main tests are: Blood tests. To determine whether the thyroid is functioning properly. […] Cervical ultrasound. To measure the size of the thyroid and detect the presence of nodules. If the thyroid is diffusely enlarged and the blood test shows hyperthyroidism (increased thyroid hormones), this will be supplemented with autoimmunity tests to help diagnose the disease. If the thyroid secretes too little hormone (hypothyroidism) it is more likely to be Hashimoto’s thyroiditis or a multinodular goitre. […] Other tests such as a cervical fine needle aspiration (FNA) or a cervical scan with radioactive iodine may be necessary to complete the diagnosis.

• #27 Goitre Causes, investigation and management

  https://www.racgp.org.au/afp/2012/august/goitre

  Goitre refers to an enlarged thyroid. […] Thyroid stimulating hormone is the appropriate first test for all patients with goitre; if this hormone is low a radionuclide scan is helpful. […] Thyroid ultrasound has become an extension of physical examination and should be performed in all patients with goitre. […] Patients with goitre or thyroid nodules should have a serum thyroid stimulating hormone (TSH) to determine the current functional status of the thyroid. […] If the TSH is abnormal, a free T4 and free T3 should also be checked. […] Thyroid ultrasound should be performed in all patients with known or suspected thyroid nodules. […] A radionuclide thyroid scan is indicated in patients with a subnormal TSH to determine the functional status of any nodules within the thyroid and the underlying cause of clinical or subclinical hyperthyroidism.

• #28 Thyroid Goiter

  https://www.thyroidcancer.com/thyroid-goiter

  Goiter means „big thyroid”. Thyroid Goiter means the same thing–the thyroid has grown to a large size. […] The diagnosis of thyroid goiter is made with a comprehensive ultrasound examination of the entire thyroid gland and neck lymph nodes. Ultrasound exposes you to no radiation whatsoever. It uses sound waves to look beneath the skin at the important structures of your neck. […] If there is a suspicion that you may have a thyroid goiter, your health care professional will want to know your complete medical history. […] Medical history and physical examination is required for all patients with a thyroid goiter. […] Thyroid goiter is a condition where there is an abnormal enlargement of your thyroid gland. […] The most common symptom from a thyroid goiter is a lump in the neck. Other symptoms from a large thyroid goiter may include a sense of a lump in the throat, difficultly swallowing, difficulty breathing and even in extreme cases, voice changes and even vocal cord paralysis.

• #29 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  If a multinodular goiter is found or suspected, a thorough history and physical exam should be performed. Important history includes how fast the thyroid is growing, risk factors for thyroid cancer (i.e. family history of cancer and history of radiation therapy to the neck or chest), family history of goiter, hoarseness, and symptoms of hyperthyroidism. Important physical exam findings include a goiter that can be felt, growth down into the chest, and enlarged neck veins. […] After a complete history and physical exam, a thyroid ultrasound (USG) should be done. There is no radiation associated with an USG. An USG is the best test to look at the thyroid and will allow the doctor to see the size of the thyroid and specific features of the nodule(s) including: size, number of nodules, if there are calcifications (calcium deposits), echotexture (i.e. how bright or dark it looks on USG), borders, shape, and if it is solid or cystic (i.e. fluid-filled).

• #30 Multinodular Goitre | Dr. Farid Meybodi, Breast & Endocrine Surgeon, Bella Vista NSW

  https://www.drfaridmeybodi.com.au/multinodular-goitre.html

  Multinodular goitre is mostly detected during a routine physical examination of the neck where your doctor will check for enlarged thyroid gland, size and shape of the nodules. […] Once a nodule is discovered, the following tests may be ordered for further details: […] Thyroid function test: This test measures blood levels of the thyroid-stimulating hormone (TSH) and helps to determine whether your thyroid gland is functioning normally or not. The test helps to detect if you have hyperthyroidism (where your thyroid gland is producing too much thyroid hormone) or hypothyroidism (where your thyroid gland is not producing enough thyroid hormone). […] Ultrasound of the thyroid: This test uses sound waves to create images of your thyroid. The test utilises a lubricating gel and a device called a transducer to gently move over your neck to look at the size and texture of the thyroid gland. This test can indicate whether a nodule is a fluid-filled cyst or a solid mass of tissue.

• #31 Clinical presentation and evaluation of goiter in adults – UpToDate

  https://www.uptodate.com/contents/clinical-presentation-and-evaluation-of-goiter-in-adults

  Clinical presentation and evaluation of goiter in adults […] The evaluation of the adult with goiter will be reviewed here. […] A goiter is defined as anything larger than these parameters. […] The clinical manifestations vary with thyroid function and with the size and location of the goiter. […] The evaluation of the adult with goiter will be reviewed here. […] Thyroid volume measured by ultrasonography is slightly greater in men than women, increases with age and body weight, and decreases with increasing iodine intake. […] However, with some goiters, there is growth of one or both lobes through the inlet into the thoracic cavity, which can result in obstruction of any of the structures in the inlet. […] Such goiters are called substernal, although retrosternal is probably a more precise term.

• #32 Approach to acquired goiter in children and adolescents – UpToDate

  https://www.uptodate.com/contents/approach-to-acquired-goiter-in-children-and-adolescents

  Approach to acquired goiter in children and adolescents […] Most children and adolescents with goiter have normal thyroid function, but some are hypothyroid or hyperthyroid, depending on the cause and stage of the disorder. […] Once a goiter is detected, the diagnostic evaluation is aimed at identifying the underlying cause and assessing thyroid function. […] The causes of and clinical approach to acquired goiters in children are discussed below. […] Thyroid volume in healthy children and adolescents — Goiter refers to enlargement of the thyroid gland; the most accurate method to determine thyroid gland volume is by ultrasonography. […] The volume of each lobe is calculated from measurements of the depth, width, and length of each lobe. […] Normal thyroid volume increases with age throughout childhood and also depends on iodine intake. […] Clinically, we use the „rule of thumb” to evaluate thyroid size in older children: Each lobe of the normal thyroid gland is approximately the size of the terminal phalanx of the child’s thumb.

• #33 Goitre Causes, investigation and management

  https://www.racgp.org.au/afp/2012/august/goitre

  Goitre refers to an enlarged thyroid. […] Thyroid stimulating hormone is the appropriate first test for all patients with goitre; if this hormone is low a radionuclide scan is helpful. […] Thyroid ultrasound has become an extension of physical examination and should be performed in all patients with goitre. […] Patients with goitre or thyroid nodules should have a serum thyroid stimulating hormone (TSH) to determine the current functional status of the thyroid. […] If the TSH is abnormal, a free T4 and free T3 should also be checked. […] Thyroid ultrasound should be performed in all patients with known or suspected thyroid nodules. […] A radionuclide thyroid scan is indicated in patients with a subnormal TSH to determine the functional status of any nodules within the thyroid and the underlying cause of clinical or subclinical hyperthyroidism.

• #34 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  Antibody test. Depending on the results of the thyroid function test, your health care provider may order a blood test to detect an antibody linked to an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease. […] Ultrasonography. Ultrasonography uses sound waves to create a computerized image of tissues in your neck. The technician uses a wand-like device (transducer) over your neck to do the test. This imaging technique can reveal the size of your thyroid gland and detect nodules. […] Radioactive iodine uptake. If your health care provider orders this test, you are given a small amount of radioactive iodine. Using a special scanning device, a technician can measure the amount and rate at which your thyroid takes it in. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern. The results may help determine function and cause of the goiter. […] Biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a very small needle into your thyroid to obtain a tissue or fluid sample from nodules. The samples are tested for the presence of cancerous cells.

• #35 Goiter > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/goiter

  A goiter is a swelling in the neck caused by an enlarged thyroid gland. […] A physician can confirm the diagnosis of goiter after obtaining a patients medical history, performing a physical exam, and through laboratory investigations and imaging studies. […] The following tests may be used to confirm a goiter diagnosis: Blood tests to assess thyroid hormone function. If the physician suspects that a goiter has been caused by autoimmune thyroid disease, they may also recommend antibody testing. […] A thyroid scan (scintigraphy), which is a nuclear medicine test. To prepare for the test, a patient is asked to ingest a small amount of radioactive iodine, which is absorbed by the thyroid, allowing the assessment of thyroid gland function. […] An ultrasound, which allows doctors to view the thyroid. Based on findings such as the presence of nodules, further assessment with a fine-needle aspiration biopsy may be advised. […] A CT scan may be recommended to assess for extension of the goiter into the chest cavity.

• #36 Goitre (Thyroid Swelling) – Types, Causes, Symptoms, Diagnosis, Treatment and Prevention

  https://www.medindia.net/health/conditions/goitre.htm

  Goitre is diagnosed based on the following: […] Physical examination is performed by a doctor who examines for signs related to thyroid enlargement, such as the size of the gland or nodule, its firmness, mobility and tenderness. […] Blood tests are performed to check for thyroid hormone levels and specific antibodies. The patient is identified to have an underactive thyroid if the TSH is elevated. Some patients with goitre may have normal thyroid hormone levels. […] If the thyroid nodule is larger than 1.01.5 cm in diameter and with TSH level of normal or high, then the patient is advised a fine needle aspiration biopsy. The biopsy may reveal a benign nodule, thyroid cancer, or an uncertain diagnosis. In some cases, an inadequate specimen may be obtained. […] Ultrasound scan or a radioactive iodine scan is performed. A thyroid sonogram or ultrasound sends inaudible sound waves into the neck in such a way that the returning echoes determine the structure of the thyroid and surrounding tissues. A radioactive scan determines if the nodule is a hot nodule (a hyperactive nodule that takes up more radioactive iodine) or a cold nodule (a hypoactive nodule that takes up less radioactive iodine). Cancerous nodules appear as cold nodules on a radioactive thyroid scan, though some benign nodules may also appear cold.

• #37 Toxic Nodule and Toxic Multinodular Goiter | American Thyroid Association

  https://www.thyroid.org/toxic-nodule-multinodular-goiter/

  Toxic nodule or toxic multinodular goiter refers to one or more nodules (typically benign growths) in the thyroid gland that make thyroid hormone without responding to the signal to keep thyroid hormone balanced. The end result is that too much thyroid hormone can be produced and released into the bloodstream, resulting in hyperthyroidism. […] The diagnosis of hyperthyroidism is made on the basis of symptoms and physical exam findings, and it is confirmed by laboratory tests showing excess thyroid hormones. In hyperthyroidism, there is a high level of thyroid hormone in the blood plus a low level of TSH. Once the diagnosis of hyperthyroidism is made, a thyroid scan can be performed. This test uses radioactive iodine to show where the thyroid is functioning. A toxic nodule appears a single area of overactivity and a toxic multinodular goiter has multiple areas. A thyroid ultrasound can also be used to better evaluate the presence of thyroid nodules.

• #38 Goitre (Thyroid Swelling) – Types, Causes, Symptoms, Diagnosis, Treatment and Prevention

  https://www.medindia.net/health/conditions/goitre.htm

  Goitre is diagnosed based on the following: […] Physical examination is performed by a doctor who examines for signs related to thyroid enlargement, such as the size of the gland or nodule, its firmness, mobility and tenderness. […] Blood tests are performed to check for thyroid hormone levels and specific antibodies. The patient is identified to have an underactive thyroid if the TSH is elevated. Some patients with goitre may have normal thyroid hormone levels. […] If the thyroid nodule is larger than 1.01.5 cm in diameter and with TSH level of normal or high, then the patient is advised a fine needle aspiration biopsy. The biopsy may reveal a benign nodule, thyroid cancer, or an uncertain diagnosis. In some cases, an inadequate specimen may be obtained. […] Ultrasound scan or a radioactive iodine scan is performed. A thyroid sonogram or ultrasound sends inaudible sound waves into the neck in such a way that the returning echoes determine the structure of the thyroid and surrounding tissues. A radioactive scan determines if the nodule is a hot nodule (a hyperactive nodule that takes up more radioactive iodine) or a cold nodule (a hypoactive nodule that takes up less radioactive iodine). Cancerous nodules appear as cold nodules on a radioactive thyroid scan, though some benign nodules may also appear cold.

• #39 Goiter & Multinodular Goiter Treatment NYC | Mount Sinai – New York

  https://www.mountsinai.org/locations/center-thyroid-parathyroid-diseases/conditions/goiter

  CT scan or MRI of the thyroid: This test, which can measure the size of a growing goiter, may be required if the goiter has spread into the chest. […] Fine needle aspiration (FNA) biopsy: This is an office test that can sample the cells in a thyroid nodule and help assess risk for malignancy. […] Treatment for goiter depends on the size of the thyroid gland, your symptoms, and the cause of your condition. […] Given these variables, your physician may recommend: […] Surgery: An operation may be recommended to remove the thyroid or part of it if the goiter is large and causing difficulties breathing and swallowing.

• #40 What Is a Goiter? What Causes Goiters?

  https://www.webmd.com/women/understanding-goiter-basics

  Goiter Diagnosis […] Often, your doctor will diagnose your goiter simply by examining your neck. You may then have tests to find out what caused it and how it affects you. They include: […] An ultrasound to see how large your thyroid is and whether you have nodules […] Blood tests to measure your thyroid hormone levels and see whether you have the antibodies that some goiters cause. Antibodies are proteins your body makes to fight infection. […] A biopsy, where your doctor uses a thin needle to take a sample of tissue or fluid for testing. This is used to rule out cancer. […] A thyroid scan, in which your doctor injects a little radioactive material to create an image of your thyroid on a computer screen. This shows your doctor the size of your thyroid and how well it’s working. […] A CT scan or MRI if your goiter is large or has spread to your chest.

• #41 Goiter > Fact Sheets > Yale Medicine

  https://www.yalemedicine.org/conditions/goiter

  A goiter is a swelling in the neck caused by an enlarged thyroid gland. […] A physician can confirm the diagnosis of goiter after obtaining a patients medical history, performing a physical exam, and through laboratory investigations and imaging studies. […] The following tests may be used to confirm a goiter diagnosis: Blood tests to assess thyroid hormone function. If the physician suspects that a goiter has been caused by autoimmune thyroid disease, they may also recommend antibody testing. […] A thyroid scan (scintigraphy), which is a nuclear medicine test. To prepare for the test, a patient is asked to ingest a small amount of radioactive iodine, which is absorbed by the thyroid, allowing the assessment of thyroid gland function. […] An ultrasound, which allows doctors to view the thyroid. Based on findings such as the presence of nodules, further assessment with a fine-needle aspiration biopsy may be advised. […] A CT scan may be recommended to assess for extension of the goiter into the chest cavity.

• #42 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  The best test to determine if a thyroid nodule is benign or cancer is a fine-needle aspiration biopsy (FNAB). In this test, a small needle (like the needles used for drawing blood) is placed into the nodule either by USG or feeling the nodule with the fingers. Cells are removed from the nodule into the needle (i.e. aspirated) and looked at under the microscope by a specially trained doctor called a cytologist. […] There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. If a patient has risk factors for thyroid cancer (especially a family history of thyroid cancer or exposure to radiation therapy) or suspicious findings on USG, then nodules over 0.5 cm should be biopsied. […] The FNAB may give one of 4 results: Non-diagnostic: This means that not enough cells were removed to make a diagnosis.

• #43 Goiter – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/goiter/diagnosis-treatment/drc-20351834

  Antibody test. Depending on the results of the thyroid function test, your health care provider may order a blood test to detect an antibody linked to an autoimmune disorder, such as Hashimoto’s disease or Graves’ disease. […] Ultrasonography. Ultrasonography uses sound waves to create a computerized image of tissues in your neck. The technician uses a wand-like device (transducer) over your neck to do the test. This imaging technique can reveal the size of your thyroid gland and detect nodules. […] Radioactive iodine uptake. If your health care provider orders this test, you are given a small amount of radioactive iodine. Using a special scanning device, a technician can measure the amount and rate at which your thyroid takes it in. This test may be combined with a radioactive iodine scan to show a visual image of the uptake pattern. The results may help determine function and cause of the goiter. […] Biopsy. During a fine-needle aspiration biopsy, ultrasound is used to guide a very small needle into your thyroid to obtain a tissue or fluid sample from nodules. The samples are tested for the presence of cancerous cells.

• #44 Thyroid Nodules | AAFP

  https://www.aafp.org/pubs/afp/issues/2013/0801/p193.html

  Thyroid nodules are a common finding in the general population. […] Measurement of thyroid-stimulating hormone can identify conditions that may cause hyperfunctioning of the thyroid. For all other conditions, ultrasonography and fine-needle aspiration are central to the diagnosis. […] Fine-needle aspiration is the procedure of choice for sampling thyroid nodules for biopsy, except for hyperfunctioning nodules, which do not require biopsy. […] A reasonable first step in evaluating a thyroid nodule is to check TSH levels and perform thyroid ultrasonography. […] If TSH is suppressed, radionuclide scintigraphy with technetium 99m or iodine 123 can determine whether there are hyperfunctioning nodules or whether the entire thyroid gland is overactive, as it would be in cases of toxic multinodular goiter.

• #45 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  The best test to determine if a thyroid nodule is benign or cancer is a fine-needle aspiration biopsy (FNAB). In this test, a small needle (like the needles used for drawing blood) is placed into the nodule either by USG or feeling the nodule with the fingers. Cells are removed from the nodule into the needle (i.e. aspirated) and looked at under the microscope by a specially trained doctor called a cytologist. […] There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. If a patient has risk factors for thyroid cancer (especially a family history of thyroid cancer or exposure to radiation therapy) or suspicious findings on USG, then nodules over 0.5 cm should be biopsied. […] The FNAB may give one of 4 results: Non-diagnostic: This means that not enough cells were removed to make a diagnosis.

• #46 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  The best test to determine if a thyroid nodule is benign or cancer is a fine-needle aspiration biopsy (FNAB). In this test, a small needle (like the needles used for drawing blood) is placed into the nodule either by USG or feeling the nodule with the fingers. Cells are removed from the nodule into the needle (i.e. aspirated) and looked at under the microscope by a specially trained doctor called a cytologist. […] There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. If a patient has risk factors for thyroid cancer (especially a family history of thyroid cancer or exposure to radiation therapy) or suspicious findings on USG, then nodules over 0.5 cm should be biopsied. […] The FNAB may give one of 4 results: Non-diagnostic: This means that not enough cells were removed to make a diagnosis.

• #47

  https://link.springer.com/article/10.1007/s12020-024-04015-8

  Due to the frequent diagnosis of benign thyroid nodules, it is necessary to deviate from the traditional paradigm based on frequent surgical treatment. […] The main challenge in the current management of thyroid nodules is avoiding overdiagnosing low-risk cancers without overlooking advanced or higher-risk tumors that require immediate treatment as overdiagnosis leads to overmedication and overtreatment. […] Significant advances in the diagnostic evaluation of thyroid nodules have been made in recent decades, including improvements in the quality of ultrasound examination. […] Ultrasound-guided fine needle aspiration biopsy remains the main method for ruling out malignancy in thyroid nodules, with reports relying on the Bethesda System for Reporting Thyroid Cytopathology. […] The cytology result plays a key role in optimizing subsequent management.

• #48 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  The best test to determine if a thyroid nodule is benign or cancer is a fine-needle aspiration biopsy (FNAB). In this test, a small needle (like the needles used for drawing blood) is placed into the nodule either by USG or feeling the nodule with the fingers. Cells are removed from the nodule into the needle (i.e. aspirated) and looked at under the microscope by a specially trained doctor called a cytologist. […] There are a number of different guidelines as to which nodules should be biopsied, but in general, nodules over 1 cm should be biopsied. If a patient has risk factors for thyroid cancer (especially a family history of thyroid cancer or exposure to radiation therapy) or suspicious findings on USG, then nodules over 0.5 cm should be biopsied. […] The FNAB may give one of 4 results: Non-diagnostic: This means that not enough cells were removed to make a diagnosis.

• #49 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  Typically the FNAB will be repeated. If the nodule grows, then a repeat biopsy will usually be performed. […] In certain cases, a patient may go straight to an operation to make a diagnosis, especially if the risk of cancer is high or if the patient has had two or more non-diagnostic FNAB in the past. […] Benign: This means that there is a 97% chance that the nodule is not cancer. […] In most cases, patients with a benign biopsy are watched with an USG and physical exam 6 months later, and then at regularly scheduled times. […] A patient with a benign nodule may still have an operation if the nodule is large, causing symptoms, or cosmetically unappealing. […] Malignant: This means that there is a 97% chance that the nodule is cancer, usually a papillary thyroid cancer. […] Much less commonly, the FNAB can show a medullary or anaplastic thyroid cancer.

• #50 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  Sometimes the cytologist reports that the nodule is „suspicious for thyroid cancer” which means that there is an 80 to 90% chance of cancer, again usually papillary thyroid cancer. […] Most patients with a FNAB of cancer will have a total thyroidectomy (i.e. removal of the entire thyroid) with or without removal of certain lymph nodes. […] Indeterminate: This category includes different readings like: follicular lesion, follicular neoplasm, Hurthle cell lesion, Hurthle cell neoplasm, and atypical cells or atypical lesions. […] This means that the cytologist cannot tell if the nodule is cancer, but the cells do not look normal. […] There is a 15 to 20% chance of having thyroid cancer with an indeterminate biopsy. […] It used to be that the only way to make a clear diagnosis of cancer or no cancer was to remove half or all of the thyroid and see if the cells in the nodule are invading (i.e. growing) the capsule of the thyroid or blood vessels within the thyroid.

• #51 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  Sometimes the cytologist reports that the nodule is „suspicious for thyroid cancer” which means that there is an 80 to 90% chance of cancer, again usually papillary thyroid cancer. […] Most patients with a FNAB of cancer will have a total thyroidectomy (i.e. removal of the entire thyroid) with or without removal of certain lymph nodes. […] Indeterminate: This category includes different readings like: follicular lesion, follicular neoplasm, Hurthle cell lesion, Hurthle cell neoplasm, and atypical cells or atypical lesions. […] This means that the cytologist cannot tell if the nodule is cancer, but the cells do not look normal. […] There is a 15 to 20% chance of having thyroid cancer with an indeterminate biopsy. […] It used to be that the only way to make a clear diagnosis of cancer or no cancer was to remove half or all of the thyroid and see if the cells in the nodule are invading (i.e. growing) the capsule of the thyroid or blood vessels within the thyroid.

• #52 Multinodular Goiter | Columbia Surgery

  https://columbiasurgery.org/conditions-and-treatments/multinodular-goiter

  Typically the FNAB will be repeated. If the nodule grows, then a repeat biopsy will usually be performed. […] In certain cases, a patient may go straight to an operation to make a diagnosis, especially if the risk of cancer is high or if the patient has had two or more non-diagnostic FNAB in the past. […] Benign: This means that there is a 97% chance that the nodule is not cancer. […] In most cases, patients with a benign biopsy are watched with an USG and physical exam 6 months later, and then at regularly scheduled times. […] A patient with a benign nodule may still have an operation if the nodule is large, causing symptoms, or cosmetically unappealing. […] Malignant: This means that there is a 97% chance that the nodule is cancer, usually a papillary thyroid cancer. […] Much less commonly, the FNAB can show a medullary or anaplastic thyroid cancer.

• #53 Multinodular Goitre | Dr. Farid Meybodi, Breast & Endocrine Surgeon, Bella Vista NSW

  https://www.drfaridmeybodi.com.au/multinodular-goitre.html

  Fine-needle aspiration (FNA) biopsy: Your doctor will use a very thin needle to withdraw cells from the thyroid nodules which are examined under a microscope. This test helps to distinguish between noncancerous and cancerous thyroid nodules. […] Thyroid scan: A lab technician introduces a tiny quantity of radioactive iodine into your bloodstream with a syringe, and a special camera captures images of the thyroid gland to view nodules – this allows your doctor to check how well the thyroid gland is functioning. This test is unsafe for the health of expectant or breastfeeding women.

• #54 Thyroid Goiter

  https://www.thyroidcancer.com/thyroid-goiter

  The thyroid goiter patient may or may not have recognized symptoms of their hyperthyroidism. […] If you have a thyroid goiter and your blood tests also demonstrate that your thyroid hormone level is too high (hyperthyroidism), this is the only instance that a radioiodine scan (thyroid scan) is indicated. […] Sometimes clearly thyroid goiters and multinodular goiters are managed with surgery. Some potential indications for removing thyroid goiters include: The thyroid goiter is large (producing a visible mass in the neck), The thyroid goiter is producing symptoms on the breathing tube or swallowing tube, The thyroid goiter is producing excessive thyroid hormone, Thyroid nodules which have Indeterminate or suspicious for cancer FNAs. […] The process of obtaining this small sampling of cells is called fine needle aspiration (FNA) cytology. […] Most FNA biopsies will show that the thyroid goiters are benign. Rarely, the FNA biopsy may come back as benign even though a diagnosis of a thyroid cancer is actually present.

• #55 Thyroid Exam | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/thyroid.html

  The thyroid exam is important as its often the first step towards diagnosing thyroid diseases such as Graves disease, Hashimotos thyroiditis and multinodular goiters. […] Assess for asymmetrical elevation of lobes (suggests nodularity). […] Diffuse Enlargement: isthmus and lateral lobes, no nodules. Graves disease, Hashimotos thyroiditis, endemic goiter. […] Single node: Cyst, benign tumor, false positive (only one nodule of multinodular goiter detected). Elevates index of suspicion for malignancy. […] Multinodular Goiter (iodine deficiency). […] Soft in Graves Disease and may have bruit. […] Firm in Hashimotos thyroiditis, malignancy, benign and malignant nodules. […] Tender in thyroiditis. […] Systolic or continuous bruit may be heard over lateral lobes in hyperthyroidism.

• #56 Hyperthyroidism: Diagnosis and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2016/0301/p363.html

  Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, excessive release of preformed thyroid hormones, or an endogenous or exogenous extrathyroidal source. […] The diagnostic workup for hyperthyroidism includes measuring thyroid-stimulating hormone, free thyroxine (T4), and total triiodothyronine (T3) levels to determine the presence and severity of the condition, as well as radioactive iodine uptake and scan of the thyroid gland to determine the cause. […] The serum level of thyroid-stimulating immunoglobulins or TSH-receptor antibodies helps distinguish Graves disease from other causes of hyperthyroidism in patients who lack signs pathognomonic of Graves disease and have a contraindication to radioactive iodine uptake and scan. […] A radioactive iodine uptake test and thyroid scan help determine the cause of hyperthyroidism. […] The thyroid scan shows the distribution of radiotracer in the gland.

• #57 Do you have a goitre? Symptoms, diagnosis and treatment | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/do-you-have-a-goitre-symptoms-diagnosis-and-treatment

  A goitre is a swelling in the neck that happens due to an enlarged thyroid gland. […] The term goitre (also spelt goiter) describes a bilateral enlargement of the thyroid gland. […] In Graves disease, the goitre is caused by an enlargement of the thyroid gland due to stimulation from the autoantibodies that bind to specific proteins present in the wall of thyroid cells. […] In Hashimoto thyroiditis, the thyroid gland is attacked by cells of the immune system. […] For the vast majority of patients with goitres, no exact cause can be easily demonstrated as they present with numerous nodules of different sizes spread throughout both lobes (a condition called multinodular goitre). […] Thyroid cancer usually presents with a unilateral thyroid nodule rather than a bilateral involvement of the thyroid but many patients with goitres are concerned that the neck swelling could be cancerous.

• #58 Simple Nontoxic Goiter – Endocrine and Metabolic Disorders – Merck Manual Professional Edition

  https://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/thyroid-disorders/simple-nontoxic-goiter

  Simple nontoxic goiter, which may be diffuse or nodular, is noncancerous hypertrophy of the thyroid gland without hyperthyroidism, hypothyroidism, or inflammation. […] Diagnosis is clinical and with determination of normal thyroid function. […] Diagnosis of Simple Nontoxic Goiter […] Thyroidal radioactive iodine uptake […] Thyroid scan […] Thyroid ultrasonography […] Thyroxine (T4), triiodothyronine (T3), and thyroid-stimulating hormone (TSH) levels. […] In the early stages, thyroidal radioactive iodine uptake may be normal or high with normal thyroid scans. […] Thyroid function test results are usually normal. […] Thyroid antibodies are measured to rule out Hashimoto thyroiditis. […] In endemic goiter, serum TSH may be slightly elevated, and serum T4 may be low-normal or slightly low, but serum T3 is usually normal or slightly elevated.

• #59 Thyroid Nodules: Causes, Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/13121-thyroid-nodule

  More than 90% of detected nodules in adults are noncancerous (benign), but they may represent thyroid cancer in approximately 4.0% to 6.5% of cases. […] Even though thyroid nodules are almost always noncancerous (benign), the small chance that it could be cancer means that most thyroid nodules need some type of evaluation. […] Your healthcare provider may order any of the following tests to help diagnose and evaluate a thyroid nodule: […] Most nodules are noncancerous. However, if the test results are inconclusive, your provider may repeat this test. […] Surgery to take out the nodules is the best treatment for nodules that are cancerous, cause obstructive symptoms like breathing or swallowing issues and are suspicious (they cant be diagnosed without being surgically removed and examined). […] If you notice a bump on your thyroid, its important to see your healthcare provider. Even though the majority of thyroid nodules are benign and cause no other symptoms, its still important to have the nodule evaluated in the small chance that its cancer.

• #60 Thyroid Exam | Stanford Medicine 25 | Stanford Medicine

  https://stanfordmedicine25.stanford.edu/the25/thyroid.html

  The thyroid exam is important as its often the first step towards diagnosing thyroid diseases such as Graves disease, Hashimotos thyroiditis and multinodular goiters. […] Assess for asymmetrical elevation of lobes (suggests nodularity). […] Diffuse Enlargement: isthmus and lateral lobes, no nodules. Graves disease, Hashimotos thyroiditis, endemic goiter. […] Single node: Cyst, benign tumor, false positive (only one nodule of multinodular goiter detected). Elevates index of suspicion for malignancy. […] Multinodular Goiter (iodine deficiency). […] Soft in Graves Disease and may have bruit. […] Firm in Hashimotos thyroiditis, malignancy, benign and malignant nodules. […] Tender in thyroiditis. […] Systolic or continuous bruit may be heard over lateral lobes in hyperthyroidism.

• #61 Do you have a goitre? Symptoms, diagnosis and treatment | Top Doctors

  https://www.topdoctors.co.uk/medical-articles/do-you-have-a-goitre-symptoms-diagnosis-and-treatment

  A goitre is a swelling in the neck that happens due to an enlarged thyroid gland. […] The term goitre (also spelt goiter) describes a bilateral enlargement of the thyroid gland. […] In Graves disease, the goitre is caused by an enlargement of the thyroid gland due to stimulation from the autoantibodies that bind to specific proteins present in the wall of thyroid cells. […] In Hashimoto thyroiditis, the thyroid gland is attacked by cells of the immune system. […] For the vast majority of patients with goitres, no exact cause can be easily demonstrated as they present with numerous nodules of different sizes spread throughout both lobes (a condition called multinodular goitre). […] Thyroid cancer usually presents with a unilateral thyroid nodule rather than a bilateral involvement of the thyroid but many patients with goitres are concerned that the neck swelling could be cancerous.

• #62 Goiter, Nontoxic Multinodular – Thyroid Gland Diseases – Endocrinology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.9.4.

  Nontoxic multinodular goiter (MNG) is a disease of the thyroid gland characterized by the presence of thyroid nodules (dominant focal structural lesions) without biochemical abnormalities of the thyroid gland. […] A goiter is defined as an enlarged thyroid gland. […] A nontoxic goiter is a goiter in a euthyroid patient. […] Serum thyroid-stimulating hormone (TSH) levels are usually obtained to rule out biochemical thyroid abnormalities; normal results usually exclude abnormal thyroid function without the need for the determination of free thyroid hormone levels. […] Thyroid ultrasonography is used for the evaluation and monitoring of the thyroid size and nodules, including their location, size (3-dimensional), echogenicity (iso-, hyper-, or hypoechogenic solid nodules; nonechogenic cysts), internal structure (homogeneous or heterogeneous), borders (clearly demarcated or fuzzy and irregular), calcifications (microcalcifications or macrocalcifications), blood supply (vascularity) of the whole parenchyma and nodules (color Doppler or power Doppler).

• #63 Toxic multinodular goitre – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/714

  Toxic multinodular goitre is most common in older patients. […] Onset of symptoms is more insidious and symptoms less dramatic than for Graves’ disease. Patients may have apathetic hyperthyroidism (minimal signs/symptoms) or sub-clinical hyperthyroidism (isolated thyroid-stimulating hormone suppression). […] Spontaneous remission is rare. Definitive treatment, most commonly radioactive iodine, is usually required. […] If untreated, complications may include sequelae of hyperthyroidism, such as cardiac dysfunction or bone loss, or tracheal compression by large goitres. […] A toxic multinodular goitre (MNG; also known as Plummer’s disease) contains multiple autonomously functioning nodules, resulting in hyperthyroidism. […] Key diagnostic factors include the presence of risk factors and goitre.

• #64 Substernal Goiters: Diagnosis and Treatment of Substernal goiters

  https://www.thyroidcancer.com/goiters/substernal-goiters

  Goiter means big thyroid and a thyroid goiter means the same thing. A substernal goiter is a condition where there is an abnormal enlargement of your thyroid gland that extends into the chest. The most common cause of substernal goiters are long standing multinodular goiters that have grown over many, many years into the chest cavity. The diagnosis of a substernal goiter is made with a comprehensive ultrasound examination of the entire thyroid gland and neck lymph nodes. Ultrasound exposes you to no radiation whatsoever. It uses sound waves to look beneath the skin at the important structures of your neck. Medical history and physical examination is required for all patients with a substernal goiter. If there is a suspicion that you may have a substernal goiter, your health care professional will want to know your complete medical history. The thyroid goiter is large (producing a visible mass in the neck). The thyroid goiter is producing symptoms on the breathing tube or swallowing tube. The thyroid goiter is producing excessive thyroid hormone. Thyroid nodules which have Indeterminate or suspicious for cancer FNAs. Multinodular goiters producing symptoms. A thyroid goiter which has progressed or remains symptomatic following RAI treatment. The process of obtaining this small sampling of cells is called fine needle aspiration (FNA) cytology. The diagnosis of thyroid nodules are frequently misinterpreted by unskilled or inexperienced Cytologists.

• #65 Substernal Goiters: Diagnosis and Treatment of Substernal goiters

  https://www.thyroidcancer.com/goiters/substernal-goiters

  Goiter means big thyroid and a thyroid goiter means the same thing. A substernal goiter is a condition where there is an abnormal enlargement of your thyroid gland that extends into the chest. The most common cause of substernal goiters are long standing multinodular goiters that have grown over many, many years into the chest cavity. The diagnosis of a substernal goiter is made with a comprehensive ultrasound examination of the entire thyroid gland and neck lymph nodes. Ultrasound exposes you to no radiation whatsoever. It uses sound waves to look beneath the skin at the important structures of your neck. Medical history and physical examination is required for all patients with a substernal goiter. If there is a suspicion that you may have a substernal goiter, your health care professional will want to know your complete medical history. The thyroid goiter is large (producing a visible mass in the neck). The thyroid goiter is producing symptoms on the breathing tube or swallowing tube. The thyroid goiter is producing excessive thyroid hormone. Thyroid nodules which have Indeterminate or suspicious for cancer FNAs. Multinodular goiters producing symptoms. A thyroid goiter which has progressed or remains symptomatic following RAI treatment. The process of obtaining this small sampling of cells is called fine needle aspiration (FNA) cytology. The diagnosis of thyroid nodules are frequently misinterpreted by unskilled or inexperienced Cytologists.

• #66

  https://link.springer.com/article/10.1007/s12020-024-04015-8

  Due to the frequent diagnosis of benign thyroid nodules, it is necessary to deviate from the traditional paradigm based on frequent surgical treatment. […] The main challenge in the current management of thyroid nodules is avoiding overdiagnosing low-risk cancers without overlooking advanced or higher-risk tumors that require immediate treatment as overdiagnosis leads to overmedication and overtreatment. […] Significant advances in the diagnostic evaluation of thyroid nodules have been made in recent decades, including improvements in the quality of ultrasound examination. […] Ultrasound-guided fine needle aspiration biopsy remains the main method for ruling out malignancy in thyroid nodules, with reports relying on the Bethesda System for Reporting Thyroid Cytopathology. […] The cytology result plays a key role in optimizing subsequent management.

• #67 Thyroid nodules: diagnosis and management | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-024-01025-4

  Thyroid nodules, with a prevalence of almost 25% in the general population, are a common occurrence. […] Several sonography-based stratification systems (such as Thyroid Imaging Reporting and Data Systems (TIRADS)) might help to predict the malignancy risk of nodules, potentially eliminating the need for biopsy in many instances. […] However, large or suspicious nodules necessitate cytological evaluation following fine-needle aspiration biopsy for accurate classification. […] In the case of cytology yielding indeterminate results, additional tools, such as molecular testing, can assist in guiding the management plan. […] A personalized, risk-based protocol promotes high-quality care while minimizing costs and unnecessary testing. […] The US Preventive Services Task Force recommends against screening for thyroid cancer in the general, asymptomatic adult population, as such screening would result in harms that outweigh potential benefits.

• #68 Thyroid nodules: diagnosis and management | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-024-01025-4

  Thyroid nodules, with a prevalence of almost 25% in the general population, are a common occurrence. […] Several sonography-based stratification systems (such as Thyroid Imaging Reporting and Data Systems (TIRADS)) might help to predict the malignancy risk of nodules, potentially eliminating the need for biopsy in many instances. […] However, large or suspicious nodules necessitate cytological evaluation following fine-needle aspiration biopsy for accurate classification. […] In the case of cytology yielding indeterminate results, additional tools, such as molecular testing, can assist in guiding the management plan. […] A personalized, risk-based protocol promotes high-quality care while minimizing costs and unnecessary testing. […] The US Preventive Services Task Force recommends against screening for thyroid cancer in the general, asymptomatic adult population, as such screening would result in harms that outweigh potential benefits.

• #69 Thyroid Nodules and Goiter | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/thyroid-nodules-goiter

  A goiter is an enlargement of the thyroid, the H-shaped gland that wraps around the front of your windpipe, just below your Adam’s apple. […] If a thyroid nodule or goiter is suspected, your doctor will examine you for signs of thyroid enlargement. Your doctor will also check to see if any lymph nodes near your thyroid are enlarged, and look for indications that you are producing too much or too little thyroid hormone. We will ask about your medical history and any symptoms you’ve been experiencing. […] You will likely need additional diagnostic tests, which may include: A thyroid ultrasound. This test beams sound waves into the neck to create images of the thyroid and surrounding tissues. A blood test for thyroid-stimulating hormone (TSH). This hormone is produced by the pituitary gland and helps regulate the production of the two thyroid hormones, triiodothyronine (T3) and thyroxine (T4). The test can rule in or out common causes of hyperthyroidism and hypothyroidism. If your TSH is low, you may have a benign thyroid tumor that is producing large amounts of thyroid hormone. If your TSH is high, you may have an underactive thyroid gland; its enlargement may stem from inflammation caused by an autoimmune disorder. Radionuclide thyroid scan. This test uses a radioactive tracer which you either swallow or have injected and a special camera to assess how your thyroid is functioning. Fine needle aspiration. During this test, a doctor will use a thin needle to remove a small amount of the nodule to check for cancer. If your TSH is normal or high and your thyroid nodule is more than -inch in diameter, you will likely need a biopsy.

• #70 Thyroid nodules: diagnosis and management | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-024-01025-4

  If a thyroid nodule is suspected, the first step is to perform dedicated ultrasonography; ultrasonography risk stratification systems can classify and estimate the likelihood of malignancy of a nodule. […] If the need for further assessment is confirmed, a fine-needle aspiration biopsy is often performed; cytology results are usually classified according to a standard cytology reporting system. […] At the end of the initial diagnosis and risk stratification procedure, over 90% of nodules are found to be benign and asymptomatic; the patients are euthyroid and require no specific treatment. […] Preservation of thyroid function is of paramount importance; several non-surgical and minimally invasive techniques are available but, if surgery is needed, the minimal possible extent should be chosen.

• #71 Thyroid nodules: diagnosis and management | Nature Reviews Endocrinology

  https://www.nature.com/articles/s41574-024-01025-4

  If a thyroid nodule is suspected, the first step is to perform dedicated ultrasonography; ultrasonography risk stratification systems can classify and estimate the likelihood of malignancy of a nodule. […] If the need for further assessment is confirmed, a fine-needle aspiration biopsy is often performed; cytology results are usually classified according to a standard cytology reporting system. […] At the end of the initial diagnosis and risk stratification procedure, over 90% of nodules are found to be benign and asymptomatic; the patients are euthyroid and require no specific treatment. […] Preservation of thyroid function is of paramount importance; several non-surgical and minimally invasive techniques are available but, if surgery is needed, the minimal possible extent should be chosen.

• #72 Goiter: What It Is, Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/12625-goiter

  If you have an enlarged thyroid gland, its still important to see your healthcare provider, since goiters have several possible causes some of which require treatment. […] Treatment for goiter depends on how large your thyroid has grown, symptoms and what caused it. […] If the goiter is a sign of another thyroid disease, like Graves disease or Hashimotos disease, the prognosis depends on the underlying cause of your thyroid enlargement.

• #73 Goiter: Types, Symptoms, Causes, Diagnosis, Treatment and More

  https://www.health.com/goiter-overview-7553735

  However, if you have abnormal thyroid hormone levels or a large goiter, your treatment options may include medication, radioactive iodine, or surgery. […] If you have an underactive or overactive thyroid, thyroid hormone replacement therapy and anti-thyroid medications can help treat goiter and restore your thyroid hormone levels. […] If you have an overactive thyroid (hyperthyroidism), radioactive iodine therapy may help shrink the goiter. […] In the case of large goiters, your healthcare provider can sometimes recommend a surgical procedure called a thyroidectomy. […] If left untreated, a goiter can lead to complicationsespecially if the condition affects your thyroid hormone levels. […] It’s important to catch these conditions early as they can improve your treatment outlook, restore your hormone levels, and reduce your symptoms.

• #74 Thyroid Nodules and Goiter | Conditions | UCSF Health

  https://www.ucsfhealth.org/conditions/thyroid-nodules-goiter

  For all patients with nodules or goiters, our goal is to answer the following questions in our evaluation: 1. Is the thyroid (or part of the gland) so large that it is stretching, compressing or invading nearby structures in the neck? 2. Is the thyroid working normally, or is it producing too much or too little thyroid hormone? 3. Is the goiter or nodule due to cancer? The answers to these questions will determine the best course of treatment for you. […] Many goiters and nodules can be followed with a „watch and wait” approach. If they are causing bothersome symptoms or impacting your health, however, they will need to be treated, often with surgery. This includes cases such as: Large goiters that are uncomfortable or cause difficulty with breathing or swallowing. Multinodular goiters, particularly those that constrict airways, the esophagus or blood vessels. Nodular goiters causing hyperthyroidism (overactive thyroid), if treatment with radioactive iodine or anti-thyroid medications are not an option. Goiters or nodules that are malignant (thyroid cancer). Thyroid nodules that produce uncertain results on a biopsy.

• #75 Goiter: Types, Symptoms, Causes, Diagnosis, Treatment and More

  https://www.health.com/goiter-overview-7553735

  However, if you have abnormal thyroid hormone levels or a large goiter, your treatment options may include medication, radioactive iodine, or surgery. […] If you have an underactive or overactive thyroid, thyroid hormone replacement therapy and anti-thyroid medications can help treat goiter and restore your thyroid hormone levels. […] If you have an overactive thyroid (hyperthyroidism), radioactive iodine therapy may help shrink the goiter. […] In the case of large goiters, your healthcare provider can sometimes recommend a surgical procedure called a thyroidectomy. […] If left untreated, a goiter can lead to complicationsespecially if the condition affects your thyroid hormone levels. […] It’s important to catch these conditions early as they can improve your treatment outlook, restore your hormone levels, and reduce your symptoms.

• #76 Become a member

  https://www.btf-thyroid.org/thyroid-nodules-and-swellingsleaflet

  A swelling in the neck due to an enlarged thyroid gland is called a goitre. Nodules are lumps in the thyroid gland. Most are harmless but you should arrange an appointment with your doctor as soon as you find a lump or swelling. […] If you have a nodule or swelling in your neck you should see your doctor with a minimum of delay. Your doctor will assess the swelling and refer you to a specialist clinic if necessary. Most nodules and swellings are harmless, but it is always best to have them checked promptly in case they are among the few that are cancerous. […] There are various tests that can be carried out to find the cause of your thyroid problem. These include: Blood tests this is usually the first test performed and is done to ensure that your thyroid is not over- or under-active. Ultrasound scan – this is painless and uses sound waves from a probe to examine the structure of the thyroid gland. It can establish the number and size of nodules in the thyroid and can give important information on the likelihood that a nodule is benign or a cancer. Fine needle aspiration cytology – this is where some cells are removed from a thyroid nodule using a thin needle. The cells are then examined under a microscope. There may be some discomfort, but the procedure is usually quite quick. X-rays – a CT scan (a special form of X-ray) may be performed to check the position of a retrosternal goitre in relation to the windpipe (trachea) and gullet (oesophagus). Nuclear medicine scan – this is a type of X-Ray that checks the size, shape, and position of the thyroid and detects areas that are over-active (hot) or under-active (cold).

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