II. Epidemiology

  1. Endemic in areas distant from sea (e.g. mountains)
    1. Common sites: Alps, Andes, and Himalayas
    2. Related to deficient Iodine intake
    3. Often occurs before Puberty
  2. Sporadic form much more common in women (8:1)
    1. Adolescent girls
    2. Pregnant, Lactating or Menopausal women

III. Criteria

  1. Diffuse Thyroid enlargement without nodularity
  2. Euthyroid function

IV. Causes

  1. Idiopathic (Sporadic)
  2. Iodine Deficiency (Endemic Goiter)
  3. Goitrogens (Thyroid suppressants)
    1. Calcium and fluorides in water
    2. Cabbage
    3. Cassava
    4. Cauliflower
    5. Brussels sprouts
    6. Turnips

V. Symptoms

  1. Often asymptomatic
  2. Thyroid sensitive to touch
  3. Dyspnea
  4. Dysphagia
  5. Cough with large glands

VI. Signs

  1. Palpable diffuse Thyroid enlargement
  2. No Thyroid nodularity

VII. Management

  1. Early Goiter
    1. Iodine replacement results in Goiter regression
  2. Late Goiter
    1. Thyroid Replacement required

VIII. Prevention

  1. Iodized Salt in diet

IX. Course

  1. If untreated, develops into Multinodular Goiter

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