How do You Get a Nodular Goiter?
- Low level TSH stimulation and goitrogens in environment cause the first step.
- Resulting hyperplasia,hypertrophy forms the Diffuse Goiter.
- Further TSH stimulation along with somatic mutations leads to follicular cell proliferation and the first sign of nodule formation.These nodules do not produce hyperthyroidism in early phase. Simple goiter is a euthyroid condition at first.
- Continuing proliferation is associated with the appearance of activating mutations of the TSH receptor.
- This leads to thyroid gland autonomy and eventually toxic nodular goiter in some cases of simple euthyroid goiter.
- Further gland growth results in compressive symptoms and degenerative changes such as cyst formation, hemorrhage, calcification, and Hurthle cell metaplasia, not Hurthle cell neoplasms.
Comments: Simple goiter is not so simple as it seems but short of cancer in a goiter there are non-surgical alternatives to treat your enlarging nodular goiter. If you have a large symptomatic solid nodule in a goiter there is radiofrequency ablation RFA therapy available to you now.If it is a big thyroid or parathyroid cyst we treat those also without surgery with ethanol ablation PEI. Call Matthew at 1310-3938860 for details about the evaluation needed for both procedures.
Richard Guttler MD.FACE,ECNU