Goitre - causes, investigation and management.

BACKGROUND

Goitre refers to an enlarged thyroid. Common causes of goitre include autoimmune disease, thyroid nodules and iodine deficiency.

OBJECTIVE

This article outlines the causes, investigation and management of goitre in the Australian general practice setting.

DISCUSSION

Patients with goitre may be asymptomatic, or may present with compressive symptoms such as cough or dysphagia. Goitre may also present with symptoms due to associated hypothyroidism or hyperthyroidism. Thyroid stimulating hormone is the appropriate first test for all patients with goitre; if this hormone is low a radionuclide scan is helpful. Thyroid ultrasound has become an extension of physical examination and should be performed in all patients with goitre. Ultrasound can determine what nodules should be biopsied. Treatment options for goitre depend on the cause and the clinical picture and may include observation, iodine supplementation, thyroxine suppression, thionamide medication (carbimazole or propylthiouracil), radioactive iodine ablation and surgery.