Multinodular goiter is very common in cases having euthyroid goiter but other conditions such as
diffuse goiter, thyroiditis and neoplasm can also be present in euthyroid state19.
TABLE 1 Clinical manifestations of hyperthyroidism (2) Acropachy (swelling of the fingers) Bruit (thyroid) Decreased attention span Diarrhea Edema Exertional dyspnea Fatigue Goiter (smooth or nodular) Gynecomastia Hair loss Heat intolerance Hyperactive deep tendon reflex Hypertension Increased appetite Infertility Insomnia Lid lag, proptosis Muscle weakness Nervousness and irritability Oligomenorrhea Palmar erythema Palpitations Paralysis (sudden) Photophobia, eye irritation, diplopia Pretibial myxedema Tachycardia Tremors Warm, moist skin Weight loss TABLE 2 Clinical and laboratory findings associated with common causes of hyperthyroidism (51-57) Mechanism Thyroid exam Lab results Graves' Antithyroid
Diffuse goiter Low TSH; disease antibodies elevated [T.
Causes of Hyperthyroidism Toxic
diffuse goiter (Graves' disease) Toxic adenoma Toxic multinodular goiter Subacute thyroiditis Hashimoto's thyroiditis Iodine-induced hyperthyroidism Excessive pituitary TSH or trophoblastic disease Excessive ingestion of thyroid hormone Table 4.
All of the cases diagnosed with grade 1 goiter were diagnosed as euthyroid
diffuse goiter after clinical evaluation and thyroid USG performed.
The background adjustment factors were outcome-specific and included sex, age at examination (10-14, 15-19, 20-24, [greater than or equal to] 25 years), oblast (an administrative subdivision similar to a state or province) of residency at examination, rural or urban residency at examination, self-reported current cigarette smoking, self-reported current vitamin consumption, self-reported history of any thyroid disease in parents or siblings, year and season of examination, level of urinary iodine (< 20, 20-49, 50-99, [greater than or equal to] 100 [micro]g/L, or unknown), presence of
diffuse goiter based on thyroid palpation, ATPO and ATG concentrations ([less than or equal to] 60, > 60 U/mL).
Radioactive iodine therapy was recommended in case of
diffuse goiter and low TRAb levels.
1) Multinodular goiter is the most common diagnosis in cases of euthyroid goiter, but other conditions such as
diffuse goiter (often idiopathic), thyroiditis, and neoplasms can also present in a euthyroid state.
The prevalence of
diffuse goiter declines with age, the greatest prevalence is in pre-menopausal women, and the ratio of women to men is at least 4:1 (4).
It also rose with younger age at exposure, and females were at a slightly increased risk over males, as were people with benign thyroid conditions such as
diffuse goiter.
In 11 younger patients, hyperthyroidism was caused by
diffuse goiter (suggesting Graves' disease) and in seven older patients by nodular goiter.
