Diffuse nontoxic goiter

Goiter - visible enlargement of the thyroid gland. Goiter occurs with various thyroid diseases and may be accompanied by clinical manifestations of hypothyroidism or thyrotoxicosis, often the symptoms of thyroid dysfunction are absent (euthyroidism). The presence of goiter itself does not allow us to establish the cause of the disease. Most children with goiter have euthyroidism. The frequency of goiter in children is 4-5% and increases with age. At the same time. The frequency of euthyroid goiter in schoolchildren is an indicator of iodine supply 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 Non-toxic diffuse goiter.
• E04.1 Non-toxic single-nodular goiter.
• E04.2 Non-toxic multinodular goiter.
• E04.8 Other specified forms of non-toxic goiter.
• E04.9 Non-toxic goiter, unspecified.

Juvenile enlargement of the thyroid gland

Juvenile enlargement of the thyroid gland (juvenile struma) is not associated with foci of goitre endemia and occurs in children during the period of increased growth and puberty. At the heart of this condition is the discrepancy between the needs of the body in thyroid hormones and their production by the thyroid gland. Usually, the increase is expressed in moderate diffuse hyperplasia. Clinical symptoms are nonspecific and are mainly due to neuro-vegetative lability inherent in pubertal age. In most children with juvenile struma, a clinical and hormonal examination reveals euthyroidism.

Classification of diffuse non-toxic goiter

Allocate the following forms of goiter.

1. Acquired nontoxic goiter.
   • Juvenile enlargement of the thyroid gland (goiter is associated with an increase in the need for iodine in the pubertal period).
   • Caused by iodine.
   • Idiopathic (sporadic).
2. Congenital non-toxic goiter.
3. Endemic goiter.
4. Goiter with thyroiditis (acute, subacute and chronic).
5. Diffuse toxic goiter.
6. Tumors of the thyroid gland.
   • Benign.
   • Malignant.

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

[1], [2]

Classification of goiter size

The traditional method of determining the size of the thyroid gland is palpation. Since 1994, on the recommendation of the WHO, the classification of the thyroid gland size, accessible to physicians of all specialties, is used internationally, which makes it possible to compare data from different countries:

• grade 0 - no goiter;
• degree I - goiter is not visible, but palpable, while the size of its lobes is greater than the distal phalanx of the thumb of the subject;
• degree II - the struma is palpable and visible to the eye.

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

Diagnosis of diffuse non-toxic goiter

To determine the exact size of the thyroid gland, ultrasound is indicated. For clinical diagnosis of an increase in the thyroid gland, there is absolutely no need to conduct an ultrasound scan with any suspicion of a goiter. In most cases, palpation is sufficient to assess the size of the thyroid gland. Conduction of ultrasound is indicated in focal formations in the thyroid gland, as well as in those cases when palpation determination of the thyroid size does not allow to give reliable results.

[7], [8], [9]