Big Thyroid Nodular Goiter 101:

Big Thyroid Nodular Goiter 101:

Big Thyroid Nodular Goiter 101:

Big Thyroid Goiter 101:unadjustednonraw_thumb_6ec1

Dr.Guttler’s 37 rules about nodular goiters.



The term “goiter” simply refers to the abnormal enlargement of the thyroid gland.

  1.  Most goiters have normal thyroid blood tests and are not malfunctioning.
  2. Some goiters can occur in a gland that is producing too much hormone (hyperthyroidism).
  3. Some with decreased thyroid hormone (hypothyroidism).
  4. However most have correct amount of hormone (euthyroidism).
  5. A goiter indicates there is a conditions present which is causing the thyroid to grow abnormally.
  6. They are Simple goiter and Hashimoto’s thyroiditis.
  7.  The primary activity of the thyroid gland is to concentrate iodine from the blood to make thyroid hormone.
  8. Simple goiter has internal defects producing small decreases in thyroid hormone with small rises in TSH to causes the growth of new thyroid tissue,and stimulates nodule formation over many years.016-2
  9. TSH rise slowly over years causes the growth of the goiter
  10. Hashimoto’s thyroiditis is a more common cause of goiter formation in the US.17068
  11. Because it is familial in nature first degree relatives should be tested with neck exam, TSH and thyroid antibodies.
  12. This is an autoimmune condition in which there is destruction of the thyroid gland by one’s own immune system.
  13. As the gland becomes more damaged, it is less able to make adequate supplies of thyroid hormone.
  14. The pituitary gland senses a low thyroid hormone level and secretes more TSH to stimulate the thyroid.
  15. This stimulation causes the thyroid to grow, which may produce a goiter, nodules and even cancer over many years before the patient becomes hypothyroid. Early intervention and treatment should begin before the patient is hypothyroid.
  16. Another common cause of goiter is Graves’ disease.
  17. Immune system produces a protein, called thyroid stimulating immunoglobulin (TSI).
  18. As with TSH, TSI stimulates the thyroid gland to enlarge producing a goiter.
  19. TSI also stimulates the thyroid to make too much thyroid hormone (causes hyperthyroidism).
  20. Since the pituitary senses too much thyroid hormone, it stops secreting TSH.
  21. In spite of this the thyroid gland continues to grow and make thyroid hormone.
  22. Therefore, Graves’ disease produces a goiter and hyperthyroidism.
  23. Multinodular goiters are another common cause of goiters.
  24.  This is often detected as a nodular feeling gland on physical exam.
  25. Patients can present with a single large nodule or with multiple smaller nodules in the gland.
  26.  The presence of a goiter indicates there is an abnormality of the thyroid gland.
  27. The treatment will depend upon the cause of the goiter.
  28. Iodine supplements can worsen goiter and Hashmoto’s in the USA.
  29. Surgery is usually not routine treatment of thyroiditis.
  30. Goiter due to hyperthyroidism, the treatment will depend upon the cause of the hyperthyroidism.
  31. Treatment of Graves’ disease with radioactive iodine usually leads to a decrease or disappearance of the goiter.61dyjtvhrml-_ac_ul130_img_0666
  32. Thyroid eye disease is a serious complication of Graves’ and if severe needs eye consultation and treatment.
  33. Many goiters, such as the multinodular goiter, are associated with normal levels of thyroid hormone in the blood.
  34. These goiters may not require any specific treatment after the appropriate diagnosis is made, accept thyroid hormone suppression for goiter growth.
  35. Problems associated with the size of the thyroid such as the goiter getting so large that it constricts the airway, your doctor may suggest that the goiter be treated by surgery or recommend Ethanol ablation PEI for complex large cysts or radiofrequency ablation RFA for mostly solid nodules, if biopsies ans marker tests are benign.%c2%a6%d0%b1%c2%a6%d1%8d%c2%a6%d1%88%c2%a6%d1%8c%c2%a6%d1%8a%c2%a6%d1%880242 %c2%a6%d0%b1%c2%a6%d1%8d%c2%a6%d1%88%c2%a6%d1%8c%c2%a6%d1%8a%c2%a6%d1%880244big-goider
  36. Call me at 310-393-8860 or email to [email protected] for a consultation on alternatives to surgery for your big symptomatic goiter nodules.
  37. Dr.G.
  • Angela November 17, 2018 4:59 pm


    I have a very large nodule that I have been trying to decrease through detoxing and other alternative methods. However, after a year of trying and waiting for surgery the nodule is getting bigger. I would prefer not to have my thyroid removed and was curious if I would be a possible candidate for your pre-evaluation. The last ultrasound I had in May 2017 indicated a well circumscribed heterogeneously hypoechoic solid nodule. There was marked internal vascularity with no cystic component or microcalcification. There was no definite extracellular extension. A biopsy was performed in November 2016 that was suspicious for follicular neoplasm.

    Thank you kindly for your time.


    • Dr Guttler November 19, 2018 1:23 pm

      Yes you could be a candidate for alternative therapy instead of surgery.
      We would need to repeat the biopsy and collect cancer markers before we could
      consider you for treatment.
      Call 310-393-8860 or email to [email protected] for full details
      from my office.

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