Goitre

Outline

Background

• Goitre is an examination finding (sign) of an enlarged thyroid

• Goitre can be caused by a range of thyroid disease that can be classified into hyperthyroidism, hypothyroidism and thyroid growths

• Goitre can affect the airway and bulbar nerves of speech and swallow 

Assessment

History

• Sensation of swollen neck

• Dysphagia, hoarse voice, tightness in throat

Examination

• Enlarged thyroid in anterior neck

• Stridor

Investigations

• TFTs: TSH, T3, T4

• Thyroid ultrasound

• Thyroid iodine uptake scan

• Thyroid biopsy- if concerned of malignancy

Diagnosis

Diagnostic criteria: clinical

Classification: 

• By aetiology, 

• By severity- stridor/ speech/ swallow changes

Differentials: parathyroid swelling, cervical lymphadenopathy, thyroglossal duct cyst (moves with swallowing)

Management

Underlying cause

• Growth: biopsy for malignancy, surgery

• Thyroid state: hypothyroidism- PO levothyroxine; hyperthyroidism- carbimazole, propranolol

• PO iodine, immunosuppression, radio-iodine, cessation of offending drug

Written in 2025.