Diffuse nontoxic goiter

Goiter is a visible enlargement of the thyroid gland. Goiter occurs with various thyroid diseases and may be accompanied by clinical manifestations of hypothyroidism or thyrotoxicosis, often symptoms of thyroid dysfunction are absent (euthyroidism). The presence of goiter in itself does not allow to establish the cause of the disease. Most children with goiter have euthyroidism. The incidence of goiter in children is 4-5% and increases with age. At the same time, the incidence of euthyroid goiter in schoolchildren is an indicator of iodine provision of the population.

ICD-10 code

• E01.0 Diffuse (endemic) goiter associated with iodine deficiency.
• E01.2 Goiter (endemic) associated with iodine deficiency, unspecified.
• E04.0 Nontoxic diffuse goiter.
• E04.1 Nontoxic uninodular goiter.
• E04.2 Nontoxic multinodular goiter.
• E04.8 Other specified forms of nontoxic goiter.
• E04.9 Nontoxic goiter, unspecified.

Juvenile thyroid enlargement

Juvenile enlargement of the thyroid gland (juvenile goiter) is not associated with foci of goiter endemia and occurs in children during periods of rapid growth and puberty. This condition is based on a discrepancy between the body's needs for thyroid hormones and their production by the thyroid gland. Usually, the enlargement is expressed as moderate diffuse hyperplasia. Clinical symptoms are nonspecific and are mainly due to the neurovegetative lability characteristic of puberty. Most children with juvenile goiter are euthyroid during clinical and hormonal examination.

Classification of diffuse nontoxic goiter

The following forms of goiter are distinguished.

1. Acquired nontoxic goiter.
   • Juvenile enlargement of the thyroid gland (goiter is associated with increased iodine requirements during puberty).
   • Caused by iodine.
   • Idiopathic (sporadic).
2. Congenital nontoxic goiter.
3. Endemic goiter.
4. Goiter in thyroiditis (acute, subacute and chronic).
5. Diffuse toxic goiter.
6. Thyroid tumors.
   • Benign.
   • Malignant.

Sometimes euthyroid goiter is mistakenly called subclinical forms of hypo- or hyperthyroid goiter. In this regard, euthyroid goiter is an indication for in-depth examination to clarify the diagnosis.

[ 1 ], [ 2 ]

Classification of goiter sizes

The traditional method for determining the size of the thyroid gland is palpation. Since 1994, the world has used, on the recommendation of the WHO, a classification of thyroid gland sizes accessible to doctors of all specialties, the international nature of which allows for comparison of data from different countries:

• degree 0 - no goiter;
• degree I - the goiter is not visible, but palpable, and the size of its lobes is larger than the distal phalanx of the thumb of the person being examined;
• Grade II - the goiter is palpable and visible to the eye.

[ 3 ], [ 4 ], [ 5 ], [ 6 ]

Diagnosis of diffuse nontoxic goiter

Ultrasound is indicated for precise determination of the thyroid gland size. For clinical diagnosis of thyroid gland enlargement, there is absolutely no need to perform ultrasound at any suspicion of goiter. In most cases, palpation examination is sufficient to assess the thyroid gland size. Ultrasound is indicated for focal lesions in the thyroid gland, as well as in cases where palpation of thyroid gland size does not provide reliable results.

[ 7 ], [ 8 ], [ 9 ]