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Thyroid lumps 

Thyroid lumps
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date: 26 June 2019

‘Goitre’ is a clinical term defined by a thyroid enlargement above the gender- and age-specific reference range (Table 3.5.1.1). Goitre may arise from very different pathological conditions (Table 3.5.1.2) and may present with euthyroid, hyperthyroid, or hypothyroid function. On morphological grounds, a goitre may be diffuse or nodular. This chapter will focus on the pathogenesis of nontoxic goitre, also called simple or dysplastic goitre in the older literature.

Nodular goitre can be divided into solitary nodular and multinodular thyroid disease and constitutes a complex thyroid disorder with heterogeneous morphological functional and pathogenetic properties (1). Histologically, thyroid nodules are distinguished by morphological criteria according to the World Health Organization classification (2). On functional grounds, nodules are classified as either ‘cold’, ‘normal’, or ‘hot’ depending on whether they show decreased, normal, or increased uptake on scintiscan. In contrast to solitary nodular thyroid disease, which has a more uniform clinical, pathological, and molecular picture, multinodular goitre (MNG) usually comprises a mixed group of nodular entities, i.e. one usually finds a combination of hyperfunctional, hypofunctional, or normally functioning thyroid lesions within the same thyroid gland. The overall balance of functional properties of individual thyroid nodules within an MNG ultimately determines the functional status in the individual patient, which may be euthyroidism, subclinical hyperthyroidism, or overt hyperthyroidism. On the molecular level, thyroid nodules within a nodular goitre may represent polyclonal lesions or true monoclonal thyroid neoplasia.

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