Goiter resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fatemeh Dehghani Firouzabadi, MD [2]


A goiter is an enlarged thyroid gland that is located in the front of your neck producing thyroid hormones. Enlarged thyroid gland is able to produce too much, a little, or enough thyroid hormones. Thyroid hormones control the metabolism rate in the different organ systems such as the heart,liver,muscles,brain, and other parts of the body. Therefore, if the amount of these hormones decreased, the metabolism rate will be declined and the body will feel tired and cold. Also, releasing too much of these hormones can increase metabolism rate leading to fell warm and nervous.There are other symptoms such as tightness in the throat,cough, hoarseness, swallowing and breathing problems due to the effect of the thyroid mass on surrounding tissues. Risk factors for goiter includes; being a woman, being over age 40, being pregnant or in menopause, having a family history of autoimmune disease or goiter, having been exposed to radiation as a child or having had radiation treatment to your neck or chest, and having a diet low in iodine. [1][2]


Common CausesCommon causes of goiter may include:

Common cause of goiter may include:

less cause of goiter may include:


Shown below is an algorithm summarizing the diagnosis of goiter according the the american thyroid association guidelines.[3][4][5]

Suspected goiter based on serum TPO antibodies, Serum TSH Serum T3, Serum T4
Increase TSH and serum TPO antibodies, Decrease T3, T4
Decrease TSH, Increase T3, T4
Hashimoto's thyroiditis
Multinodular goiter(MNG) or Grave's disease


Shown below is an algorithm summarizing the treatment of goiter according the the american thyroid association guidelines.[6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]

Radioactive Iodine
Lugol's iodine
Antithyroid drugs such as carbimazole, methimazole
β-adrenergic blockers such as propranolol


  • The content in this section is in bullet points.


  • The content in this section is in bullet points.


  1. Template:Cite journal.
  2. . PMID 23008749  Check |pmid= value (help). Missing or empty |title= (help)
  3. Ris-Stalpers, Carrie; Bikker, Hennie (2010). "Genetics and phenomics of hypothyroidism and goiter due to TPO mutations". Molecular and Cellular Endocrinology. 322 (1–2): 38–43. doi:10.1016/j.mce.2010.02.008. ISSN 0303-7207.
  4. Babademez, Mehmet Ali; Tuncay, Kenan Selçuk; Zaim, Murat; Acar, Baran; Karaşen, Rza Murat (2010). "Hashimoto Thyroiditis and Thyroid Gland Anomalies". Journal of Craniofacial Surgery. 21 (6): 1807–1809. doi:10.1097/SCS.0b013e3181f43e32. ISSN 1049-2275.
  5. Frilling, A.; Liu, C.; Weber, F. (2016). "Benign Multinodular Goiter". Scandinavian Journal of Surgery. 93 (4): 278–281. doi:10.1177/145749690409300405. ISSN 1457-4969.
  6. Astwood, E. B. (1960). "Treatment of Goiter and Thyroid Nodules with Thyroid". JAMA. 174 (5): 459. doi:10.1001/jama.1960.03030050001001. ISSN 0098-7484.
  7. Führer, Dagmar; Bockisch, Andreas; Schmid, Kurt Werner (2012). "Euthyroid Goiter With and Without Nodules". Deutsches Aerzteblatt Online. doi:10.3238/arztebl.2012.0506. ISSN 1866-0452.
  8. Sawin, Clark T. (1989). "The Aging Thyroid". JAMA. 261 (18): 2653. doi:10.1001/jama.1989.03420180077034. ISSN 0098-7484.
  9. Wesche, Maria F. T.; Tiel-v Buul, Monique M. C.; Lips, Paul; Smits, Nico J.; Wiersinga, Wilmar M. (2001). "A Randomized Trial Comparing Levothyroxine with Radioactive Iodine in the Treatment of Sporadic Nontoxic Goiter". The Journal of Clinical Endocrinology & Metabolism. 86 (3): 998–1005. doi:10.1210/jcem.86.3.7244. ISSN 0021-972X.
  10. Baskin, H. Jack; Cobin, Rhoda H.; Duick, Daniel S.; Gharib, Hossein; Guttler, Richard B.; Kaplan, Michael M.; Segal, Robert L.; Garber, Jeffrey R.; Hamilton, Carlos R.; Handelsman, Yehuda; Hellman, Richard; Kukora, John S.; Levy, Philip; Palumbo, Pasquale J.; Petak, Steven M.; Rettinger, Herbert I.; Rodbard, Helena W.; Service, F. John; Shankar, Talla P.; Stoffer, Sheldon S.; Tourtelot, John B. (2002). "AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS MEDICAL GUIDELINES FOR CLINICAL PRACTICE FOR THE EVALUATION AND TREATMENT OF HYPERTHYROIDISM AND HYPOTHYROIDISM". Endocrine Practice. 8 (6): 457–469. doi:10.4158/1934-2403-8.6.457. ISSN 1530-891X.
  11. Bonnema, Steen J.; Bertelsen, Henrik; Mortensen, Jesper; Andersen, Peter B.; Knudsen, Dorthe U.; Bastholt, Lars; Hegedüs, Laszlo (1999). "The Feasibility of High Dose Iodine 131 Treatment as an Alternative to Surgery in Patients with a Very Large Goiter: Effect on Thyroid Function and Size and Pulmonary Function*". The Journal of Clinical Endocrinology & Metabolism. 84 (10): 3636–3641. doi:10.1210/jcem.84.10.6052. ISSN 0021-972X.
  12. Nygaard, Birte; Knudsen, Jens Helmer; Hegedüs, Laszlo; Scient, Annegrete Veje Cand; Mølholm Hansen, Jens Erik (1997). "Thyrotropin Receptor Antibodies and Graves' Disease, a Side-Effect of131I Treatment in Patients with Nontoxic Goiter1". The Journal of Clinical Endocrinology & Metabolism. 82 (9): 2926–2930. doi:10.1210/jcem.82.9.4227. ISSN 0021-972X.
  13. Greer, Monte A.; Astwood, E. B. (1953). "TREATMENT OF SIMPLE GOITER WITH THYROID*". The Journal of Clinical Endocrinology & Metabolism. 13 (11): 1312–1331. doi:10.1210/jcem-13-11-1312. ISSN 0021-972X.
  14. Squatrito, S.; Vigneri, R.; Rybello, F.; Ermans, A. M.; Polley, R. D.; Ingbar, S. H. (1986). "Prevention and Treatment of Endemic Iodine-Deficiency Goiter by Iodination of a Municipal Water Supply*". The Journal of Clinical Endocrinology & Metabolism. 63 (2): 368–375. doi:10.1210/jcem-63-2-368. ISSN 0021-972X.
  15. Hegedüs, Laszlo; Bonnema, Steen J. (2010). "Approach to Management of the Patient with Primary or Secondary Intrathoracic Goiter". The Journal of Clinical Endocrinology & Metabolism. 95 (12): 5155–5162. doi:10.1210/jc.2010-1638. ISSN 0021-972X.
  16. Haines, Samuel F.; Keating, F. Raymond; Power, Marschelle H.; Williams, Marvin M. D.; Kelsey, Mavis P. (1948). "THE USE OF RADIOIODINE IN THE TREATMENT OF EXOPHTHALMIC GOITER*". The Journal of Clinical Endocrinology & Metabolism. 8 (10): 813–825. doi:10.1210/jcem-8-10-813. ISSN 0021-972X.
  17. Reveno, William S. (1948). "PROPYLTHIOURACIL IN THE TREATMENT OF TOXIC GOITER". The Journal of Clinical Endocrinology & Metabolism. 8 (10): 866–874. doi:10.1210/jcem-8-10-866. ISSN 0021-972X.
  18. Brenta, G.; Schnitman, M.; Fretes, O.; Facco, E.; Gurfinkel, M.; Damilano, S.; Pacenza, N.; Blanco, A.; Gonzalez, E.; Pisarev, M. A. (2003). "Comparative Efficacy and Side Effects of the Treatment of Euthyroid Goiter with Levo-Thyroxine or Triiodothyroacetic Acid". The Journal of Clinical Endocrinology & Metabolism. 88 (11): 5287–5292. doi:10.1210/jc.2003-030095. ISSN 0021-972X.
  19. Abraham-Nordling, Mirna; Törring, Ove; Hamberger, Bertil; Lundell, Göran; Tallstedt, Leif; Calissendorff, Jan; Wallin, Göran (2005). "Graves' Disease: A Long-Term Quality-of-Life Follow Up of Patients Randomized to Treatment with Antithyroid Drugs, Radioiodine, or Surgery". Thyroid. 15 (11): 1279–1286. doi:10.1089/thy.2005.15.1279. ISSN 1050-7256.
  20. Anyetei-Anum, Cyril S; Roggero, Vincent R; Allison, Lizabeth A (2018). "Thyroid hormone receptor localization in target tissues". Journal of Endocrinology. 237 (1): R19–R34. doi:10.1530/JOE-17-0708. ISSN 0022-0795.

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