Goiter and Benign Thyroid Nodules

A goiter is an abnormal enlargement of the thyroid gland typically detected on physical exam as a palpable neck mass or incidentally on imaging performed for an unrelated indication. While the prevalence rate of thyroid nodules detected on ultrasound ranges between 19 and 68%, a vast majority of these nodules are benign and classified as goiters. Goiters can be further subclassified based on the pattern of growth, thyroid hormone levels, and/or underlying etiology. Given the high likelihood of encountering a patient presenting with a thyroid nodule, it is paramount to have an in-depth understanding of the diagnosis and management of goiters. As such, the objectives of this chapter are to discuss the etiology and pathogenesis of goiters. Subsequently, students will learn how to obtain a focused history and perform a physical examination to identify and characterize goiters. Next, a detailed work-up including biochemical and imaging tests will be reviewed to formulate a thorough differential diagnosis. Ultimately, clinical management algorithms differentiating between conservative versus surgical management of this common endocrine pathology will be presented.