Definition
A goitre is an enlargement of the thyroid gland from any cause.
Key Points
- Toxic goitres are rarely malignant.
- In hyperthyroidism serum TSH is low and serum T4 and T3 are high.
- In hypothyroidism TSH is high and T4 is low.
- All solitary nodules should have U/S, radionuclide imaging, FNAC) to exclude carcinoma.
- Surgery is rarely necessary in autoimmune or inflammatory thyroid disease.
Common Causes
- Physiological: gland increases in size as a result of increased demand for thyroid hormone at puberty and during pregnancy.
- Iodine deficiency (endemic): deficiency of iodine results in decreased T4 levels and increased TSH stimulation leading to a diffuse goitre.
- Primary hyperthyroidism (Graves’ disease): goitre and thyrotoxicosis due to circulating immunoglobulin LATS.
- Adenomatous (nodular) goitre: benign hyperplasia of the thyroid gland.
- Thyroiditis: autoimmune (Hashimoto’s); subacute (de Quervain’s); Riedel’s (struma).
- Thyroid malignancies.
Clinical Features
Hyperthyroidism
Symptoms
- Heat intolerance and excessive sweating.
- Increased appetite, weight loss, diarrhoea.
- Anxiety, tiredness, palpitations.
- Oligomenorrhoea.
Signs
- Goitre.
- Exophthalmos, lid lag and retraction.
- Warm moist palms, tremor.
- Atrial fibrillation.
- Pretibial myxoedema.
Hypothyroidism
Symptoms
- Cold intolerance, decreased sweating.
- Hoarseness.
- Weight increase, constipation.
- Slow cerebration, tiredness.
- Muscle pains.
Signs
- Pale/yellow skin, dry, thickened skin, thin hair.
- Periorbital puffiness, loss of outer third of eyebrow.
- Dementia, nerve deafness, hyporeflexia.
- Slow pulse, large tongue, peripheral oedema.
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