
Multinodular Goitre
Endocrine system
Multinodular Goitre (MNG)
A multinodular goitre is an enlargement of the thyroid gland characterized by the presence of multiple nodules. It is a common condition, especially in areas where dietary iodine is insufficient, and can lead to both cosmetic concerns and functional thyroid disorders.
Causes and Risk Factors:
• Iodine Deficiency: The most common cause in endemic areas.
• Genetic Factors: Familial predisposition can contribute.
• Thyroid-Stimulating Hormone (TSH) Stimulation: Chronic stimulation due to suboptimal thyroid hormone production.
• Age and Gender: More common in older adults and women.
Clinical Features:
• Neck Swelling: Progressive enlargement of the thyroid gland.
• Compression Symptoms: Large goitres can compress nearby structures, causing:
o Difficulty swallowing (dysphagia).
o Shortness of breath (dyspnea) due to tracheal compression.
o Hoarseness if the recurrent laryngeal nerve is involved.
• Thyroid Dysfunction:
o Euthyroid (normal function) in most cases.
o Hyperthyroid (toxic multinodular goitre) or hypothyroid in some cases.
Gross Appearance:
• Size and Shape:
o Enlarged thyroid gland with multiple nodules of varying sizes.
• Nodules:
o Well-demarcated, often with cystic areas, hemorrhage, fibrosis, or calcifications.
• Surface:
o Irregular, lobulated surface.
• Cut Surface:
o Nodules may be colloid-filled, cystic, or solid.
Microscopic Appearance:
• Nodules:
o Composed of variably sized follicles, often with abundant colloid.
• Follicular Cells:
o Follicular hyperplasia (proliferation) and areas of degeneration.
• Stromal Changes:
o Fibrosis, hemorrhage, and calcifications are common.
• Cystic Changes:
o Cystic degeneration may be present, contributing to the multinodular appearance.
Diagnosis:
• Clinical Examination: Palpation of a multinodular thyroid gland.
• Ultrasound:
o Confirms the presence of multiple nodules and helps assess nodule characteristics (solid vs. cystic, calcifications).
• Thyroid Function Tests:
o Evaluates thyroid hormone levels (T3, T4, TSH).
• Fine-Needle Aspiration (FNA):
o Performed for suspicious nodules to rule out malignancy.
• Radioisotope Scan:
o Distinguishes between "hot" (functional) and "cold" (non-functional) nodules.
Management:
• Observation: For asymptomatic, euthyroid patients with benign findings.
• Thyroid Hormone Suppression Therapy: May reduce goitre size but is not always effective.
• Radioactive Iodine Therapy: Useful in toxic multinodular goitre to reduce thyroid activity.
• Surgery: Indicated for:
o Large goitres causing compression symptoms.
o Suspicion of malignancy.
o Cosmetic concerns.
Multinodular Goitre (MNG)
A multinodular goitre is an enlargement of the thyroid gland characterized by the presence of multiple nodules. It is a common condition, especially in areas where dietary iodine is insufficient, and can lead to both cosmetic concerns and functional thyroid disorders.
Causes and Risk Factors:
• Iodine Deficiency: The most common cause in endemic areas.
• Genetic Factors: Familial predisposition can contribute.
• Thyroid-Stimulating Hormone (TSH) Stimulation: Chronic stimulation due to suboptimal thyroid hormone production.
• Age and Gender: More common in older adults and women.
Clinical Features:
• Neck Swelling: Progressive enlargement of the thyroid gland.
• Compression Symptoms: Large goitres can compress nearby structures, causing:
o Difficulty swallowing (dysphagia).
o Shortness of breath (dyspnea) due to tracheal compression.
o Hoarseness if the recurrent laryngeal nerve is involved.
• Thyroid Dysfunction:
o Euthyroid (normal function) in most cases.
o Hyperthyroid (toxic multinodular goitre) or hypothyroid in some cases.
Gross Appearance:
• Size and Shape:
o Enlarged thyroid gland with multiple nodules of varying sizes.
• Nodules:
o Well-demarcated, often with cystic areas, hemorrhage, fibrosis, or calcifications.
• Surface:
o Irregular, lobulated surface.
• Cut Surface:
o Nodules may be colloid-filled, cystic, or solid.
Microscopic Appearance:
• Nodules:
o Composed of variably sized follicles, often with abundant colloid.
• Follicular Cells:
o Follicular hyperplasia (proliferation) and areas of degeneration.
• Stromal Changes:
o Fibrosis, hemorrhage, and calcifications are common.
• Cystic Changes:
o Cystic degeneration may be present, contributing to the multinodular appearance.
Diagnosis:
• Clinical Examination: Palpation of a multinodular thyroid gland.
• Ultrasound: Confirms the presence of multiple nodules and helps assess nodule characteristics (solid vs. cystic, calcifications).
• Thyroid Function Tests:
o Evaluates thyroid hormone levels (T3, T4, TSH).
• Fine-Needle Aspiration (FNA):
o Performed for suspicious nodules to rule out malignancy.
• Radioisotope Scan:
o Distinguishes between "hot" (functional) and "cold" (non-functional) nodules.
Management:
• Observation: For asymptomatic, euthyroid patients with benign findings.
• Thyroid Hormone Suppression Therapy: May reduce goitre size but is not always effective.
• Radioactive Iodine Therapy: Useful in toxic multinodular goitre to reduce thyroid activity.
• Surgery: Indicated for:
o Large goitres causing compression symptoms.
o Suspicion of malignancy.
o Cosmetic concerns.