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Key Features

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  • Firm, freely movable, nontender, diffusely enlarged thyroid gland

  • Thyroid function is usually normal but may be elevated or decreased depending on the stage of the disease

  • Most common cause of goiter and acquired hypothyroidism in childhood

  • More common in girls, and the incidence peaks during puberty

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Clinical Findings

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  • Onset is usually insidious

  • Occasionally patients note a sensation of tracheal compression or fullness, hoarseness, and dysphagia

  • No local signs of inflammation or systemic infection are present

  • A detailed family history may reveal the presence of multiple autoimmune diseases in family members

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Diagnosis

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  • Laboratory findings vary

  • Serum concentrations of TSH, T4, and FT4 are usually normal

  • Some patients are hypothyroid with an elevated TSH and low thyroid hormone levels

  • A few patients are hyperthyroid with a suppressed TSH and elevated thyroid hormone levels

  • Thyroid antibodies (antithyroglobulin, antithyroid peroxidase) are frequently elevated

  • Thyroid uptake scan adds little to the diagnosis

  • Surgical or needle biopsy is diagnostic but seldom necessary

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Treatment

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  • Whether treatment is needed when thyroid function is normal is controversial

  • Full replacement doses of thyroid hormone may decrease the size of the thyroid, but may also result in hyperthyroidism

  • Hypothyroidism commonly develops over time; consequently, patients require lifelong surveillance

  • Children with documented hypothyroidism should receive thyroid hormone replacement

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