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Colloidal goitre
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Colloid goitre
A colloid goitre is a benign, usually non-toxic, diffuse enlargement of the thyroid gland in which many thyroid follicles become enlarged and filled with stored thyroid material called colloid.
It is typically a late stage of diffuse hyperplastic simple goitre: after prolonged TSH stimulation, the stimulation decreases and follicles become inactive but remain colloid-filled. [Bailey and Love's Short Practice of Surgery, p. 1198]
Clinical features
- Often occurs in young adults, commonly around 20-30 years.
- Painless, slowly growing swelling in the front of the neck.
- Thyroid is usually diffusely enlarged, smooth, soft, and elastic.
- It moves upward on swallowing.
- Usually euthyroid, meaning there are no symptoms of hyperthyroidism or hypothyroidism.
- Very large goitres may rarely cause pressure symptoms: dysphagia, dyspnoea, venous engorgement, or neck discomfort. [S Das A Manual on Clinical Surgery, p. 370]
Causes / pathogenesis
Common contributors to simple goitre include:
- Iodine deficiency
- Increased physiologic demand, such as puberty or pregnancy
- Goitrogenic substances or drugs
- Genetic defects affecting thyroid-hormone synthesis
Low thyroid hormone production raises TSH, causing diffuse thyroid hyperplasia. Later, when TSH stimulation falls, follicles involute and become distended with colloid.
Investigations
- Serum TSH first, with free T4 if abnormal.
- Thyroid ultrasonography if there is nodularity, asymmetry, rapid enlargement, or concern for compression.
- Fine-needle aspiration is considered for a suspicious or clinically important nodule, not routinely for a typical diffuse goitre.
Treatment
- Observe if small, asymptomatic, and thyroid function is normal.
- Correct iodine deficiency where present, without taking excess iodine supplements.
- Treat thyroid dysfunction if identified.
- Surgery may be considered for marked cosmetic concern, compressive symptoms, substernal extension, suspected cancer, or uncertain diagnosis.
Seek prompt medical review for rapid growth, hoarseness, persistent difficulty swallowing or breathing, a hard fixed lump, enlarged neck nodes, or new symptoms of thyroid overactivity.
What is colloid
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thyroid colloid thyroglobulin thyroid hormone storage educational
In the thyroid, colloid is the thick, jelly-like material inside each thyroid follicle.
It consists mainly of thyroglobulin, a protein that stores iodine and the raw material for thyroid hormones (T3 and T4). When the body needs thyroid hormone, thyroid cells take up colloid and release T3 and T4 into the blood.
So, in colloid goitre, the thyroid enlarges because many follicles become distended with this stored colloid. [Ganong's Review of Medical Physiology, p. 317]
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