How to Manage a Goiter
- History: symptoms of compression or cancer, family history,exposure to goitrogens, and comorbidities.
- Physical examination: Visual inspection, palpation, auscultation,Pemberton’s maneuver ( hands over your head looking at neck veins )
- Imaging: ultrasound, CT, MR, Thyroid Scan, Plain film of neck.
- Thyroid function : Radioiodine uptake, Free T4, TSH
- Pulmonary function: upper airway obstruction by goiter by flow volume loop study.
- Cytology: FNA,needle washout studies for classifier, molecular markers, thyroglobulin calcitonin, and Parathyroid hormone.