Sporadic Nontoxic Goiter

The term goiter (L. guttur, throat) refers to an enlarged thyroid gland, but what constitutes "enlargement" is often not clearly defined.1 Goiters can be classified according to prevalence of the disease, thyroid function, location of the thyroid (neck or mediastinum), morphology, or underlying etiology (Table 4-1).

Sporadic nontoxic goiter (SNG) may be diffuse or nodular, is associated with normal thyroid function, develops in subjects living in an iodine-sufficient area, and does not result from an inflammatory or neoplastic process.2 Endemic goiter is present when more than 10% of the population living in a specific geographic area have a goiter. The term sporadic goiter is used in regions with normal iodine intake and a lower prevalence of goiter. Worldwide, endemic goiter is the most common endocrine disorder, occurring in more than 850 million people, or 7% of the world population. It occurs almost exclusively in the iodine-deficient areas. Sporadic goiter affects about 5% of the adult population in the United States.3

Sporadic nodular goiter is a common clinical entity. Patients often present with small, diffuse, or nodular goiters or have a solitary palpable nodule. In addition, recent studies using high-resolution ultrasonography and previous autopsy studies document that up to 50% of the general population have thyroid nodules, even when the thyroid gland is normal to palpation. In addition, about 50% of individuals with a solitary thyroid nodule to palpation have other smaller thyroid nodules by ultrasound examination.4

There are numerous unresolved issues regarding the etiology, natural history, evaluation, and optimal management of persons with goiter.5 Goiter represents an impairment of the thyroid gland's function, growth, and size. The problems that arise in patients with goiter include the following:

• Growth of the gland causing compressive symptoms or cosmetic problems (Fig. 4-1)

• Development of subclinical or overt thyrotoxicosis or hypothyroidism

• Risk of malignancy in nodular goiter

• Cretinism or congenital hypothyroidism, as occurs in as many as 10% of infants born in areas of severe iodine deficiency1

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