A goitre is an enlargement of the thyroid gland (Fig. 25). It can result from physiological causes such as puberty (due to increased demand for thyroid hormone) which require no treatment, to frank malignant disease requiring urgent diagnosis and treatment. The patient presents with a swelling in the neck. Physiological causes include puberty and pregnancy. Iodine deficiency is the most common cause but is rare in the UK, where iodide is added to table salt. Where the condition is endemic (often in isolated mountainous regions such as Nepal), iodine deficiency is the usual cause. This is the commonest cause of goitre in the UK. It is more common in women. The usual presentation is a lump in the neck, which moves on swallowing, but with a very large gland, the patient may complain of dyspnoea or dysphagia. The patient presents with a lump in the neck. He or she may indicate a preference for cold weather, and may also complain of excessive sweating, tiredness, anxiety, increased appetite, weight loss, diarrhoea, palpitations and tremor.
Goitre
History
Simple hyperplastic goitre
Multinodular goitre
Toxic goitre
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