Nontoxic Multinodular Goiter Differential Diagnosis Table

Nontoxic Multinodular Goiter Differential Diagnosis Table:

Non-toxic multinodular goiter is the overgrowth of thyroid tissues in the form of nodules in the thyroid gland. It’s a very common condition that usually arises from iodine deficiency.
Non-toxic multinodular goiter is often asymptomatic with normal thyroid function and normal thyroid hormones. The only symptoms a patient may feel are when the nodules start to grow, causing neck swelling and possibly coughing and hoarseness of voice.
After initial investigation, a thyroid ultrasound of the neck is usually the first step for diagnosing any abnormality in thyroid structure. Furthermore, to confirm the diagnosis of non-toxic multinodular goiter and rule out malignancy, fine needle aspiration of thyroid tissue is needed for histopathology. A thyroid function test is necessary to make sure thyroid function is normal.
In most cases, when there are no symptoms, the patient may not need any treatment at all. Only if the goiter has grown to cause any symptoms or become visible, then medical treatment like iodine may help in shrinkage of the goiter, or surgical removal may be an option too.

How To Distinguish Nontoxic Multinodular Goiter From Other Conditions

Distinguish Thyroid Nodules from Nontoxic Multinodular Goiter – Diagnosis

Thyroid nodules are lumps that may be filled with fluid or may be solid. Thyroid nodules are very common and usually are completely harmless. They have many types, and they can also form due to inflammation or swollen tissue. Most commonly, these nodules are asymptomatic, but sometimes they can lead to the overproduction of thyroid hormones.

• Neck ultrasound is usually the initial step for diagnosis of any abnormality in the neck.
• Fine needle aspiration biopsy is usually needed to rule out malignancy and give a definitive diagnosis.

Distinguish Solitary Thyroid Nodule from Nontoxic Multinodular Goiter – Diagnosis

Solitary thyroid nodules are single thyroid nodules that occur in children and adults. They usually occur due to past exposure to radiation or the past presence of nodules. Solitary thyroid nodules have a higher risk of malignancy than other types of nodules.

• Fine needle aspiration biopsy is a diagnostic tool to confirm the diagnosis.
• Neck ultrasound is used for initial investigation.
• Thyroid profile may be needed to monitor any change or abnormality in thyroid hormones.

Distinguish Hashimoto’s Thyroiditis from Nontoxic Multinodular Goiter – Diagnosis

Hashimoto’s thyroiditis is an autoimmune disease that causes the body to attack thyroid tissue, causing destruction in thyroid tissues and cells, leading to a decrease in thyroid production and symptoms of hypothyroidism. Hashimoto’s itself can lead to goiter.

• The most confirmative diagnostic test for Hashimoto’s is the presence of thyroid peroxidase (TPO) antibody in the blood. Nearly all patients with Hashimoto’s test positive for TPO antibody.
• Thyroid function tests are required to confirm hypothyroidism, usually: a high level of TSH and low levels of T4 and T3.

Distinguish Graves’ Disease from Nontoxic Multinodular Goiter – Diagnosis

Graves’ disease is an autoimmune condition that causes the body to attack the thyroid gland, leading to increased thyroid hormone and signs and symptoms of hyperthyroidism. It’s the most common cause of hyperthyroidism. Treatment of Graves’ is usually by medications, but in some cases, surgery may be required.

• Diagnosis of Graves’ usually depends on blood tests to detect thyroid-stimulating antibodies and TBII (thyrotropin-binding inhibitory immunoglobulins).
• Thyroid function test is needed to confirm hyperthyroidism (low TSH, high T4, and high T3).
• Thyroid uptake and scan: oral radioactive iodine is taken to see and detect the uptake of the thyroid gland and its function.

Distinguish Thyroiditis Disease from Nontoxic Multinodular Goiter – Diagnosis

Thyroiditis is an inflammation of the thyroid gland. It’s not a disease itself but rather a condition occurring due to a variety of diseases. Presence of thyroiditis may cause general symptoms like swelling in the neck, hoarseness of the voice, and coughing. To know the exact cause of thyroiditis, a lot of general tests are needed.

• Thyroid ultrasound: may be the first step to see swelling of the neck and detect the presence of a mass or nodules.
• Thyroid function tests: are needed to confirm the presence of either hypothyroidism or hyperthyroidism.
• Eventually, other blood tests like TPO or TSI may be needed to confirm or exclude the presence of autoimmune conditions.
• Other tests like CRP, ESR, and CBC are required to monitor the progress of the condition and may reflect the presence of infection causing thyroiditis.

Distinguish Papillary Thyroid Cancer from Nontoxic Multinodular Goiter – Diagnosis

Papillary thyroid cancer (PTC) is the abnormal growth of thyroid tissue. It accounts for almost 80% of thyroid malignancies worldwide. PTC is mostly asymptomatic, and most patients won’t feel any symptoms until the appearance of a mass or a nodule in the neck, maybe with some difficulty in swallowing and breathing. Treatment usually involves the surgical removal of the gland along with lymph nodes if metastasis occurs.

• Usually, thyroid ultrasound is the first step for diagnosis, to detect swelling and abnormal growth of the gland.
• Fine needle aspiration biopsy is the confirmative diagnosis for the presence of a benign or malignant tumor.
• Thyroid function tests are also needed to see if the tumor affects thyroid gland function.

Distinguish Follicular Thyroid Cancer from Nontoxic Multinodular Goiter – Diagnosis

Follicular thyroid cancer is the second most common type of thyroid cancer. Unlike papillary thyroid cancer, it has a very low chance of metastasizing to lymph nodes. It has a very good prognosis and is highly treatable. Surgical removal is the mainstay treatment, possibly followed by radiation and chemotherapy if needed.

• Usually, thyroid ultrasound is the first step for diagnosis, to detect swelling and abnormal growth of the gland.
• Fine needle aspiration biopsy is the confirmative diagnosis for the presence of a benign or malignant tumor.
• Thyroid function tests are also needed to see if the tumor affects thyroid gland function.

“Usually, follicular thyroid cancer and papillary thyroid cancer have the same diagnostic tests. Only fine needle aspiration can detect the difference between the two types of cancer.”

Distinguish Thyroid Cancer Disease from Nontoxic Multinodular Goiter – Diagnosis

Thyroid cancer is the abnormal growth of thyroid tissue into either benign or malignant tumors. Thyroid cancer is relatively common, and depending on its type and stage, prognosis and treatment may differ. Most thyroid cancers are asymptomatic, especially at first. The first symptom patients usually notice is an abnormal lump in the neck.

• The first step of diagnosis is usually thyroid ultrasound or any thyroid imaging to detect the presence of mass or nodules that cause an abnormal mass.
• If the doctor suspects a tumor after imaging, a fine needle aspiration is needed to detect the type of tumor.
• Thyroid function tests are routinely done to follow up on any changes in thyroid function, since the gland may have been affected by the tumor.

Distinguish Thyroid Lymphoma Disease from Nontoxic Multinodular Goiter – Diagnosis

Thyroid lymphoma is when lymphocytes within the thyroid gland become cancerous. Thyroid lymphoma most commonly occurs in people with a history of Hashimoto’s disease. This type of cancer has a poor prognosis, low survival rate, and high metastasis. Treatment usually involves chemotherapy.

• Diagnosis initially depends on thyroid imaging; either CT neck, MRI, or thyroid ultrasound for detection of abnormal tissue growth.
• Confirmative diagnosis based on biopsy by fine needle aspiration to confirm lymphoma; further immunophenotyping is needed to detect the exact type of lymphoma.
• Thyroid function tests are routinely needed for follow-up of any abnormal thyroid function.

Important Red Flags In Nontoxic Multinodular Goiter

Nontoxic multinodular goiter is usually an asymptomatic disease that may not cause any symptoms or complications, but in some cases, the disease may progress badly leading to complications.
An important red flag in nontoxic multinodular goiter is difficulty swallowing (dysphagia). This usually indicates that the nodule is very large, which may further lead to difficulty in breathing if the nodule presses on the trachea.
Another common red flag is hoarseness of voice, which may reflect a problem in the vocal cords or that the nodules have caused vocal cord dysfunction.
Presence of lymphadenopathy may reflect that the condition is not benign, and a tumor may have metastasized to lymph nodes.