Nontoxic Goiter

Abstract

Goiter is a nonspecific term referring to any enlargement of the thyroid gland. However, in common use, it mainly denotes benign causes of thyroid enlargement, such as toxic multinodular goiter, diffuse toxic goiter (Graves’ disease), or nontoxic multinodular goiter. Although malignant enlargement of the thyroid gland can technically be considered a goiter, it is usually referred to as a mass or nodule. Nontoxic goiters may remain asymptomatic, or they may give rise to compressive features such as dyspnea, dysphagia, or venous congestion/discomfort with certain movements. Surgical management is the mainstay of treatment for symptomatic, nontoxic goiter and is generally well tolerated, even in patients with limited physiologic reserve. The operation should typically by a bilateral procedure, removing all, or nearly all, of both thyroid lobes, in addition to any substernal extension. The operation is nearly always limited to a cervical incision, with median sternotomy or posterolateral thoracotomy being necessary only very rarely in previously unoperated patients. In experienced centers, complication rates are low (<2%) with techniques that include careful hemostasis and liberal parathyroid autotransplantation.