Epidemiological classification
The development of the pathology is closely related to geographical and exogenous factors. Depending on the conditions of occurrence, two main types of the disease are distinguished:
- Endemic goiter. It develops in patients living in geographical regions with objectively confirmed iodine deficiency.
- Sporadic goiter. It occurs in areas with adequate iodine supply, where the total prevalence of goiter among the population does not exceed 5%. The main etiological cause in this case is external triggers. These include cigarette smoking, past infectious diseases, contact with certain chemical compounds, and side effects from taking certain medications.
Forms of the disease and diagnostic criteria
The primary diagnosis is always established during a physical examination using palpation, after which it is mandatory to verify it instrumentally via ultrasound examination (US).
The following clinical variants are distinguished:
- Nontoxic (euthyroid) diffuse goiter. It is characterized by a uniform, symmetrical increase in the volume of the thyroid gland. The hormonal background remains within normal limits.
- Nodular goiter. This is a collective clinical term combining any volumetric formations of the gland—ranging from completely asymptomatic colloid nodules to various morphological types of tumors.
Ultrasound size assessment: Specialists clearly distinguish between true nodules and small foci. Normally, individual large thyroid follicles can reach a size of 0.5 cm. Therefore, formations with a diameter of less than 1 cm are classified exclusively as focal changes. Clinically significant nodules are recognized only as those structures whose diameter is equal to or exceeds 1 cm.
Features of the clinical course and outcome
The pathogenesis may involve the so-called hyperthyroid phase (hashitoxicosis). Its main distinguishing feature from classical diffuse toxic goiter is an asymptomatic course or an extremely mild clinical picture of thyrotoxicosis. In the vast majority of cases, this condition does not require the prescription of specific drugs (antithyroid drugs).
A natural consequence of disease progression is the development of hypothyroidism (decreased glandular function). This outcome serves as an absolute indication for prescribing lifelong hormone replacement therapy to the patient.
Patient management tactics
In an uncomplicated course, conservative tactics are used: the patient is indicated for dynamic monitoring by a subspecialist and the prescription of individual iodine prophylaxis (usually potassium iodide preparations are used).
If suspicious changes are detected during the examination, the patient is referred for fine-needle aspiration biopsy (FNAB). Indications for it include:
- Presence of nodular formations with a diameter of 1 cm and more.
- Clinically significant (very rapid) growth of those nodules that were previously identified.
- Any suspicion of a malignant tumor process (assessed by the clinical picture or specific ultrasound criteria).
Important: the final choice of further treatment strategy—to continue conservative observation or perform surgical intervention—is based exclusively on the results of the cytological examination of the material obtained by biopsy.
For biopsy indications, remember the "1-2-3 Rule": 1 — size from 1 cm, 2 — twofold (rapid) growth, 3 — malignancy (suspicion).
Class and exam questions
Why are formations up to 1 cm not considered nodular goiter?
Normally, individual large thyroid follicles are capable of reaching 0.5 cm. Therefore, smaller formations are not classified as true nodules, but are called focal changes.
Is it necessary to prescribe antithyroid drugs in hashitoxicosis?
As a rule, no. The hyperthyroid phase in this disease proceeds asymptomatically or with a mild clinical picture, without requiring aggressive therapy.
On what basis does the doctor decide whether surgery is needed?
The determination of further tactics (observation or surgery) is based exclusively on the results of the cytological examination of the biopsy sample obtained via FNAB.
What else to study on this topic
- Mechanisms of formation of thyroid colloid nodules
- Specific ultrasound criteria for malignancy of nodular formations
- Principles of individual iodine prophylaxis with potassium iodide preparations
- Differential diagnosis of hashitoxicosis and diffuse toxic goiter
- Regimens of lifelong hormone replacement therapy in case of progression to hypothyroidism
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Other topics in the section «Chapter 11. Endocrine Diseases in Children»
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