Internal Medicine

0521779407-08 CUNY1086/Karliner 0 521 77940 7 June 13, 2007 7:47

Goiter 639

Signs & Symptoms

■Neck enlargement: obtain duration and rate; painful or not

■Compressive symptoms: neck pressure, dyspnea, dysphagia

■Persistent hoarseness

■Goiter: diffuse or nodular, soft or firm, tender or not

■Associated cervical adenopathy

■Pemberton sign: facial congestion with redness or cyanosis when

arms raised above head (suggests large substernal goiter)

tests

Laboratory

■Basic blood tests: free T4, TSH

■Specific Diagnostic Tests

➣Blood: antithyroid antibodies (anti-TPO, antithyroglobulin),

occasional serum thyroglobulin

Imaging

■Thyroid ultrasound to evaluate for cysts, nodules,, and follow growth

■CT of neck and chest PRN to evaluate tracheal and esophageal inte-

grity in large or substernal goiters

differential diagnosis

■Benign goiters:

➣Autoimmune thyroid disease (AITD): Hashimoto or Graves dis-

ease

➣Idiopathic diffuse and multinodular goiter

➣Iodine deficiency

➣Goitrogens: lithium, food and water supply

➣Rare: enzyme defects, thyroid hormone resistance

■Malignant goiters:

➣Follicular carcinoma

➣Anaplastic carcinoma

➣Primary lymphoma

management

What to Do First

■Assess degree of severity using rate of growth, airway integrity, diffi-

culty swallowing

General Measures

■Assess for discomfort from goiter and risk of surgery, including car-

diac disease