Goiter history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Reddy Kothagadi M.B.B.S[2]
Overview
Obtaining history may provide important information in the diagnosis of goiter. It provides insight into cause, precipitating factors and associated comorbid conditions. Patients of goiter usually have a history of low iodine intake, history of use of therapeutic drugs that hinder normal thyroid hormonal activity, radiation exposure and positive family history of thyroid diseases. Common symptoms of goiter include, swelling at the base of the neck, difficulty swallowing, hoarseness of voice and difficulty in breathing.
History and Symptoms
History
Obtaining history may provide important information in the diagnosis of goiter. It provides insight into cause, precipitating factors and associated comorbid conditions. Patients with goiter may have a history of:
- Low iodine intake (geographical/regional factors and food habits),
- History of the use of therapeutic drugs that hinder normal thyroid hormonal activity,
- Radiation exposure (therapeutic or accidental exposure),
- Positive family history of thyroid diseases (benign or malignant variants).
Symptoms
Symptoms of of a patient suspected of goiter are evaluated based on:[1][2][3]
- Age of the patient
- Gender of the patient
- Major presenting complaints:
- Pressure-related symptoms:
- Dysphagia
- Dyspnea
- Hoarseness of voice
- Venous engorgement of the neck (especially on raising hands above head- Pemberton's sign)
- Review of systems to assess toxicity:
- CNS: tremors, irritability, mental instability
- CVS: palpitation, dyspnea, orthopnoea
- GI: Change of appetite, constipation, diarrhea
- Musculoskeletal system: Bone pain, weight change, heat or cold preference, and excessive sweating
- Past medical history:
- Previous medication, previous history of radiation exposure
- Family and social history:
- History of goiter in the family or in the community
Common Symptoms
Common symptoms of goiter include:[4][5][6][7][8]
- Swelling at the base of the neck
- Dysphagia (difficulty swallowing)
- Hoarseness (hoarse voice)
- Feeling of fullness sometimes accompanied by choking sensation
- Dyspnea (difficulty breathing)
- Cough
Less Common Symptoms
Less common symptoms of goiter include
- Pain in the area of enlargement/swelling
- Wheeze
- Phrenic nerve paralysis[9]
- Jugular vein compression or thrombosis (rare)[10]
- Cerebrovascular steal syndromes (rare) [10]
- Superior vena cava syndrome (rare) [10]
References
- ↑ Kahaly GJ, Dillmann WH (2005). "Thyroid hormone action in the heart". Endocr Rev. 26 (5): 704–28. doi:10.1210/er.2003-0033. PMID 15632316.
- ↑ Refetoff S, Bassett JH, Beck-Peccoz P, Bernal J, Brent G, Chatterjee K; et al. (2014). "Classification and proposed nomenclature for inherited defects of thyroid hormone action, cell transport, and metabolism". J Clin Endocrinol Metab. 99 (3): 768–70. doi:10.1210/jc.2013-3393. PMC 3942236. PMID 24823702.
- ↑ Cooper DS (2007). "Approach to the patient with subclinical hyperthyroidism". J Clin Endocrinol Metab. 92 (1): 3–9. doi:10.1210/jc.2006-2472. PMID 17209221.
- ↑ Bahn RS, Castro MR (2011). "Approach to the patient with nontoxic multinodular goiter". J Clin Endocrinol Metab. 96 (5): 1202–12. doi:10.1210/jc.2010-2583. PMID 21543434.
- ↑ Hegedüs L, Bonnema SJ, Bennedbaek FN (2003). "Management of simple nodular goiter: current status and future perspectives". Endocr Rev. 24 (1): 102–32. doi:10.1210/er.2002-0016. PMID 12588812.
- ↑ Ket S, Ozbudak O, Ozdemir T, Dertsiz L (2004). "Acute respiratory failure and tracheal obstruction in patients with posterior giant mediastinal (intrathoracic) goiter". Interact Cardiovasc Thorac Surg. 3 (1): 174–5. doi:10.1016/S1569-9293(03)00270-6. PMID 17670208.
- ↑ Krohn K, Führer D, Bayer Y, Eszlinger M, Brauer V, Neumann S; et al. (2005). "Molecular pathogenesis of euthyroid and toxic multinodular goiter". Endocr Rev. 26 (4): 504–24. doi:10.1210/er.2004-0005. PMID 15615818.
- ↑ Thieblemont C, Mayer A, Dumontet C, Barbier Y, Callet-Bauchu E, Felman P; et al. (2002). "Primary thyroid lymphoma is a heterogeneous disease". J Clin Endocrinol Metab. 87 (1): 105–11. doi:10.1210/jcem.87.1.8156. PMID 11788631.
- ↑ Nielsen J, Pedersen FM, Knudsen F, Jensen MB, Ibsen M (1993). "Accuracy of 94 anaesthetic agent vaporizers in clinical use". Br J Anaesth. 71 (3): 453–7. PMID 8398533.
- ↑ 10.0 10.1 10.2 Siderys H, Rowe GA (1970). "Superior vena caval syndrome caused by intrathoracic goiter". Am Surg. 36 (7): 446–50. PMID 4913941.