08/06/2020
goiter can present as a palpable or visible enlargement of the thyroid gland at the base of the neck. A goiter, if associated with hypothyroidism or hyperthyroidism, may be present with symptoms of the underlying disorder. For hyperthyroidism, the most common symptoms are associated with adrenergic stimulation: tachycardia (increased heart rate), palpitations, nervousness, tremor, increased blood pressure and heat intolerance. Clinical manifestations are often related to hypermetabolism, (increased metabolism), excessive thyroid hormone, an increase in oxygen consumption, metabolic changes in protein metabolism, immunologic stimulation of diffuse goitre, and ocular changes (exophthalmos).[4] Hypothyroid individuals may have weight gain despite poor appetite, cold intolerance, constipation and lethargy. However, these symptoms are often non-specific and make diagnosis difficult.

Goitre Class II

Goitre Class III

Goitre Class III
Worldwide, the most common cause for goitre is iodine deficiency, commonly seen in countries that scarcely use iodized salt. Selenium deficiency is also considered a contributing factor. In countries that use iodized salt, Hashimoto's thyroiditis is the most common cause.[5] Goitre can also result from cyanide poisoning; this is particularly common in tropical countries where people eat the cyanide-rich cassava root as the staple food.[6]
CausePathophysiologyResultant thyroid activityGrowth patternTreatmentIncidence and prevalencePrognosisIodine deficiencyHyperplasia of thyroid to compensate for decreased efficacyCan cause hypothyroidismDiffuseIodineConstitutes over 90% cases of goitre worldwide[3]Increased size of thyroid may be permanent if untreated for around five yearsCongenital hypothyroidismInborn errors of thyroid hormone synthesisHypothyroidismGoitrogen ingestionAdverse drug reactionsHashimoto's thyroiditisAutoimmune disease in which the thyroid gland is gradually destroyed. Infiltration of lymphocytes.HypothyroidismDiffuse and lobulated[7]Thyroid hormone replacementPrevalence: 1 to 1.5 in a 1000Remission with treatmentPituitary diseaseHypersecretion of thyroid stimulating hormone, almost always by a pituitary adenoma[8]DiffusePituitary surgeryVery rare[8]Graves' disease—also called Basedow syndromeAutoantibodies (TSHR-Ab) that activate the TSH-receptor (TSHR)HyperthyroidismDiffuseAntithyroid agents, radioiodine, surgeryWill develop in about 0.5% of males and 3% of femalesRemission with treatment, but still lower quality of life for 14 to 21 years after treatment, with lower mood and lower vitality, regardless of the choice of treatment[9]ThyroiditisAcute or chronic inflammationCan be hyperthyroidism initially, but progress to hypothyroidismThyroid cancerUsually uninodularOverall relative 5-year survival rate of 85% for females and 74% for males[10]Benign thyroid neoplasmsUsually hyperthyroidismUsually uninodularMostly harmless[11]Thyroid hormone insensitivitySecretional hyperthyroidism,
Symptomatic hypothyroidismDiffuse
Sarcoidosis
Amyloidosis
Hydatidiform mole
Cysts