History Thyroid enlargement and thyroid nodules are common in the general population. Endocrine Surgery (Chirurgische Arbeitsgemeinschaft Endokrinologie CAEK) the European Thyroid Association and the American Thyroid Association. Results There have been very few randomized trials concerning the diagnosis and treatment of goiter. Nodular goiter can be managed by watchful waiting drug treatment (initially with levothyroxine and iodide) radioactive iodine therapy or surgery. Conclusion Many patients with nodules need no treatment at all. Treatment is indicated however if the Sema3f patient U-10858 can be symptomatic and/or comes with an autonomously working (“popular”) nodule or if tumor can be suspected. Potentially cancerous nodules should be managed on. If euthyroid nodular goiter is usually to be treated with the primary objective of size decrease either medical procedures or radioactive iodine therapy could be used. Medications can be an choice for little nodules or goiters but iatrogenic hyperthyroidism should be avoided at all costs. The type of follow-up that is required depends on the chosen treatment. Goiter is defined as a thyroid gland that is larger than the upper limit of normal for the patient’s age and sex: 18 mL for women 25 mL for men. Goiter is a physical U-10858 finding not an illness in itself. It has many causes and can take on many shapes (Table 1). Moreover it can be associated with a euthyroid hyperthyroid or hypothyroid metabolic state. In this review we discuss two entities: euthyroid diffuse goiter and nodular goiter (with one or more nodules). Little scientific evidence is available to date on the diagnosis and treatment of diffuse and nodular goiter. We therefore present and discuss the relevant recommendations of thyroid specialty societies from Germany and abroad. Table 1 Causes of thyroid enlargement (goiter) Learning objectives The purpose of this article is to enable readers to recognize the importance of an etiological diagnostic work-up for diffuse or nodular goiter understand the use of particular diagnostic tests as part of this work-up and gain an overview of the current scientific evidence regarding the treatment options for diffuse and nodular goiter. Definition Goiter is defined as a thyroid gland whose volume exceeds 18 mL (for a woman) or 25 mL (for a man). The epidemiology U-10858 and clinical features of diffuse and nodular goiter Thyroid enlargement and thyroid nodules are common in the general population. In the first phase of the Study of Health in Pomerania (SHIP) whose results U-10858 were published in 2003 35.9% of the 3941 probands not previously known to have thyroid disease had a goiter and 20.2% had thyroid nodules (1). In the Papillon study in which 96 278 working adults without known thyroid disease were examined 9.7% had a goiter and 23.3% had thyroid nodules. The prevalence of the two conditions is correlated with the eating intake of iodine closely. In the lately published 5-season follow-up study from the Dispatch cohort both circumstances were discovered to have grown to be rarer as iodine consumption increased (e1). The pathogenesis of diffuse and nodular goiter is U-10858 certainly proven in Statistics 1 and graphically ?and22 (3 5 e2). Body 1 The multifactorial origins of goiter: The main known preventable reason behind thyroid enhancement is iodine insufficiency. The prevalence of goiter is certainly directly linked to iodine insufficiency and will reduce when the iodine intake of the population … Body 2 Hypothetical style of the pathogenesis of nodular goiter: Nodular goiters have become heterogeneous within their useful U-10858 structural and molecular hereditary features (4). It really is currently believed that in people with both a hereditary predisposition and an iodine … Goiter is certainly asymptomatic generally (4); it might be suspected if the individual has noticed a big change in training collar size or has stopped putting on necklaces or turtleneck sweatshirts. Thyroid enhancement to a size of 40 mL or even more is generally noticeable (4). Mechanical compression from the trachea and/or esophagus was discovered to be there in 30% to 85% from the patients within a operative case series also in some who had been evidently asymptomatic (4). The positioning of the goiter and the dynamics of its growth determine whether and how it will produce symptoms: Retrosternal.