Goiter and Thyroid Nodules

by Carlo Raj, MD

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    Here, we’ll take a look at the differences of goiter versus nodules. By the time we’re done with this section, you should be able to clearly define the differences between the two so that you never get confused on the wards or on your boards. Let’s take a look at goiter, defined as a large thyroid, period. Here, in the neck of this patient, a pretty large thyroid gland. Multiple etiologies of goiter including hypo or hyperthyroidism; could be physiologic, lack of hormone production. What happens if your thyroid hormone is not coming out? The feedback mechanism increases TSH from the anterior pituitary, bombards your thyroid gland and may result in a goiter. If you don’t have iodine, once again, increased TSH bombarding the thyroid gland resulting in enlargement. Foods… important; goitrogens, drugs that suppress synthesis of thyroid hormones, enzyme deficiencies of hormone synthesis… number of causes of goiter. Does not describe the functional status of the thyroid, that’s important for you to understand whereas the nodules will. So, just because you find a thyroid… a goiter, an enlargement of the thyroid gland doesn’t necessarily mean that you have a hyper or hypofunctioning thyroid, you just know that there is a pathology. If it’s non-toxic, we call that euthyroid; if it’s a toxic type of goiter, it’s hyperthyroid. Stop here for one second. Last time we talked about toxic was either solitary or multi… multitoxic type of goiter, multinodular toxic and those were the elderly patients that are presenting with hyperthyroidism… elderly, nodular. Okay, so, when we talk about nodules, this is interesting. With nodules, it means that the… well, this area within the thyroid gland is either taking up iodine or it’s not. If it’s taking it up and it’s focal, you call this a hot nodule, focal… focal...

    About the Lecture

    The lecture Goiter and Thyroid Nodules by Carlo Raj, MD is from the course Thyroid Gland Disorders.

    Included Quiz Questions

    1. Foods/drugs that suppress synthesis of thyroid hormone
    2. Antigens to thyroid tissue causing enlarged thyroid
    3. Autoimmune process which causes goiters
    4. Enzymes that break down goiters, return thyroid to normal size
    5. Found inside thyroid nodules
    1. Always denotes pathologic malfunctioning of thyroid
    2. Can be physiologic
    3. Defined as large thyroid
    4. Can be caused by lack of iodine
    5. Can be caused by goitrogens
    1. Is a focal area that does not take up iodine on RAI scan
    2. Is always malignant
    3. Shows diffuse RAI uptake
    4. Is the most common cause of goiter
    5. Is always substernal
    1. Fine needle aspiration/biopsy
    2. Ultrasound
    3. TSH levels
    4. MRI
    5. RAI scan

    Author of lecture Goiter and Thyroid Nodules

     Carlo Raj, MD

    Carlo Raj, MD

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