who classification of goitre
Reading File
Finding Sources
Searching PubMed
goiter classification WHO
Searching the Web
WHO goitre classification grade 0 1 2 1994
WHO simplified classification of goitre
| Grade | Definition |
|---|---|
| Grade 0 | No goitre: thyroid is not palpable and not visible. |
| Grade 1 | Goitre is palpable but not visible when the neck is in the normal position. A thyroid nodule in an otherwise non-enlarged gland is included here. |
| Grade 2 | Thyroid swelling is clearly visible with the neck in the normal position and is palpable. |
A thyroid lobe is considered enlarged when it is larger than the terminal phalanx of the examined person's thumb. For community iodine-deficiency surveys, total goitre rate (TGR) = Grade 1 + Grade 2. The older WHO system with Grades 1A and 1B was replaced by this simplified classification. WHO goitre assessment manual
clinical presentation/ manifestations of goitre
Reading File
Finding Sources
Finding Sources
Searching PubMed
goiter clinical manifestations
Searching the Web
goiter symptoms compressive symptoms American Thyroid Association
Reading File
Clinical presentation and manifestations of goitre
A goitre is enlargement of the thyroid gland. Many patients, especially with small goitres and normal thyroid function, are asymptomatic.
1. Local neck manifestations
- Visible swelling in the lower anterior neck, which typically moves upward on swallowing
- Feeling of neck fullness, heaviness, tightness, or cosmetic concern
- Enlarging collar size or inability to wear necklaces comfortably
- A diffuse, nodular, or asymmetric thyroid swelling on examination
- Occasionally pain or tenderness, particularly with thyroiditis or hemorrhage into a nodule
2. Pressure or compressive symptoms
These occur with large goitres, especially retrosternal goitres.
- Dyspnoea, exercise intolerance, or choking sensation from tracheal compression
- Stridor or worsening breathlessness when lying down, in severe airway compression
- Dysphagia, usually for solids, from oesophageal compression
- Cough, throat irritation, or a globus sensation
- Hoarseness or voice change, due to recurrent laryngeal nerve involvement or compression
- Facial congestion, distended neck veins, dizziness, or headache on raising both arms, known as Pemberton sign, suggesting thoracic inlet obstruction
Retrosternal goitres particularly tend to cause dysphagia, while retrotracheal goitres more often cause dyspnoea. Scott-Brown's Otorhinolaryngology Head & Neck Surgery, Vol 1, lines 6243-6255.
3. Manifestations due to thyroid hormone status
| Thyroid functional state | Clinical features |
|---|---|
| Euthyroid goitre | No systemic hormone-related symptoms; usually only swelling or pressure symptoms |
| Hyperthyroid or toxic goitre | Palpitations, tachycardia, tremor, heat intolerance, sweating, weight loss despite good appetite, anxiety/irritability, increased bowel frequency, proximal muscle weakness, menstrual disturbance; Graves disease may include eye signs |
| Hypothyroid goitre | Fatigue, weight gain, cold intolerance, constipation, dry coarse skin, hair loss, slow pulse, hoarse voice, depression, menorrhagia, slowed growth/development in children |
4. Findings that suggest malignancy or require urgent assessment
- Rapid increase in the size of the neck swelling
- A hard, irregular, fixed thyroid nodule
- Persistent hoarseness or vocal-cord paralysis
- Cervical lymph-node enlargement
- New dysphagia, stridor, or progressive breathlessness
- History of head and neck irradiation or strong family history of thyroid cancer
Hard fixed nodules, ipsilateral lymphadenopathy, vocal-cord paralysis, and rapid enlargement are concerning features described in Scott-Brown's Otorhinolaryngology Head & Neck Surgery, Vol 1, lines 6275-6281. The American Thyroid Association also lists trouble swallowing, choking, shortness of breath, and neck pressure as symptoms of compressive thyroid enlargement.
This is a shared conversation. Sign in to Orris to start your own chat.