Diffuse Goitre: Key Facts

Multinodular

Smooth

Plummer’s vs. Graves

Plummer’s

Older
Nodular enlargement
No extra features
AF in 40%
No assoc. AI disease

Graves’

Younger
Diffuse enlargement
Extra Features
Eye signs
Dermopathy
Acropachy
AF relatively uncommon
a/w AI disease

Simple Colloid Goitre

Grave’s Disease: ↑ uptake

Thyroiditis: ↓ uptake
Hashimoto’s
de Quervain’s
Subacute lymphocytic: post-partum
Riedel’s

Epidemiology

Features

Pathology of Eye Disease

Association

Prev: 0.5%
60% of cases of thyrotoxicosis
Sex: F>>M=9:1
Age: 40-60yrs

Diffuse goitre w/ bruit

Triggers: stress, infection, child-birth

Ophthalmopathy
Oedema: periorbital and chemosis
Exophthalmos → exposure keratopathy
Ophthalmoplegia: esp. upgaze palsy
Optic neuropathy: ↓ acuity and RAPD

Dermopathy: pre-tibial myxoedema

Acropachy: periosteal reaction (clubbing is soft tissue)

Exophthalmos

Lid-lag

Retro-orbital inflammation and lymphocytic
infiltration → orbital oedema

secondary to anti-TSH abs

Not Graves’ specific

Sympathetic overstimulation → restrictive
myopathy of LPS

T1DM

Vitiligo

Pernicious anaemia

Medical: propranolol + carbimazole

Radioiodine

Surgical: subtotal or total thyroidectomy

Features

Mx
Most pts. don’t require intervention

Commonest goitre in UK

Progression of simple diffuse goitre to nodular
enlargement.

Middle-aged women

Positive family Hx

Over-activity in parts may → mild thyrotoxicosis
Plummer’s Syndrome

Malignant change occurs in 5% of untreated MNGs

Non-Surgical

Surgical

Thyroxine → regression in 50-70%
Suppress TSH

Toxic Multinodular Goitre

Propranolol + carbimazole

Radioiodine

Indications: 5 Ms

Mechanical obstruction

Malignancy

Marred beauty: cosmetic reasons

Medical Rx failure: thyrotoxicosis

Mediastinal extension: can’t monitor changes

Procedure

Total thyroidectomy

Removes risk of malignant change in thyroid
remnant

Hyperplasia of gland secondary to ↑TSH release

Causes

Iodine deficiency: commonest worldwide

↑ physiological demand: pregnancy, puberty

Goitrogens: e.g. Li, uncooked cabbage

Not usually required

Thyroxine or ↑ dietary iodine