ICD-9: 240.0


A goiter is an enlargement or hyperplasia of the thyroid gland. A simple goiter is any thyroid enlargement that is not caused by an infection or neoplasm and that does not result from another hypothyroid or hyperthyroid disorder. It is classified as endemic or sporadic. Endemic or colloid goiter is the result of insufficient dietary intake of iodine. Sporadic or nontoxic goiter follows ingestion of certain drugs or food. Simple goiter is more common in women, especially during adolescence, pregnancy, and menopause. During these times, the body’s demand for thyroid hormone is increased.


The thyroid gland hyperplasia that characterizes a goiter occurs when the thyroid gland cannot secrete sufficient levels of the two iodine-rich hormones: thyroxine (T4) and triiodothyronine (T3). The thyroid gland tissue enlarges to compensate for the deficiency. In simple goiter, the inadequate secretion of these thyroid hormones may be caused by a dietary iodine deficiency, the ingestion of substances known to induce goiter (goitrogens), or some error in the hormone formation process within the thyroid gland. Risk factors include being female, over age 40, and having a family history of goiter. In many cases, though, the condition is idiopathic.


Signs and Symptoms

The extent of thyroid enlargement varies from case to case. A simple goiter may appear as a small nodule, or it can be quite massive, presenting a conspicuous swollen mass at the front of the neck, just above the sternum. The goiter shown in Figure is more commonly seen in countries that, unlike the United States, do not put iodized salt in foods. The goiter may compress the esophagus or trachea, producing dysphagia, dyspnea, dizziness, and syncope.

 Haitian woman with nontoxic goiter

FIGURE. Haitian woman with nontoxic goiter. ( James Gray, MissionFoto, Gosport, IN.)

Diagnostic Procedures

A thorough history and physical examination to rule out disorders with similar clinical effects, such as Graves disease and Hashimoto thyroiditis, is necessary. Diagnosis of simple goiter is made on the basis of thyroid gland enlargement in the presence of normal levels of T3 and T4 hormones. A T3 and T4 radioimmunoassay test accurately measures the levels of these two hormones. If an ultrasound locates any nodules, a biopsy is necessary to check for thyroid cancer.



The treatment goal is to reduce the size of the goiter. How this is accomplished depends in part on the underlying cause of the condition. Treatment procedures may include dietary supplements of iodine or T3 and T4 hormone replacement therapy. Sporadic goiter requires avoidance of known goitrogenic foods and drugs. A large goiter that is unresponsive to therapy may require excision, resulting in lifelong thyroid replacement therapy.

Complementary Therapy

Nutritional supplements may be helpful. A diet that includes iodized salt but that avoids goitrogenic foods is recommended; those foods include rutabagas, cabbage, peas, spinach, radishes, soybeans, peanuts, peaches, and pears, all which contain agents that decrease T4 production.



Iodized salt should be used to supply the daily 150 to 300 mg of iodine necessary to prevent goiters. Measuring the neck circumference to monitor for progressive thyroid enlargement may be beneficial.


The prognosis is generally good following effective treatment. Complications from severe cases of simple goiter include tachycardia, congestive heart failure, and atrial fibrillation.


Prevention of simple goiter includes adequate dietary intake of iodine.

PARATHYROID GLAND DISEASES AND DISORDERS The parathyroids are four small glands surrounding the thyroid in the neck. They are quite small — about the size of a grain of rice. These glands produce the parathyroid hormone (PTH), the purpose of which is to maintain the balance of calcium and phosphorus in the bloodstream and serve as an antagonist to calcitonin secreted by the thyroid gland. See Figure. A dysfunction of the glands causes either hyperparathyroidism (too much calcium in the blood or hypercalcemia) or hypoparathyroidism (too little calcium in the blood or hypocalcemia). Both conditions can cause a number of complications. FIGURE. Posterior view of thyroid gland.
DIABETES MELLITUS ICD-9: 250.xx Description Diabetes mellitus is a chronic disorder of carbohydrate metabolism resulting from insufficient production of insulin or from inadequate utilization of this hormone by the body’s cells. Insulin is produced by the beta cells within structures called the islets of Langerhans scattered throughout the pancreas. Insulin acts to lower the levels of glucose in the blood by enabling glucose absorption by body cells. When the beta cells cannot produce sufficient levels of insulin, the glucose concentration in the blood rises to abnormally high levels, a condition called hyperglycemia. Deprived of glucose, the principal fuel of the body’s cells, they begin to metabolize fats and proteins, depositing unusually high levels of wastes called ketones in the blood and causing a condition called diabetic ketoacidosis. These two conditions, hyperglycemia and diabetic ketoacidosis, are responsible for the host of troubling and often life-threatening symptoms of diabetes melli...
HYPERPITUITARISM (GIGANTISM, ACROMEGALY) ICD-9: 253.0 Description Hyperpituitarism is the hypersecretion of human growth hormone (hGH) by the anterior pituitary or adenohypophysis gland. Two distinct conditions may result from hyperpituitarism, depending on the time of life at which this dysfunction begins. Gigantism results from the hypersecretion of hGH during an individual’s growing years, especially before puberty. The person with gigantism grows abnormally tall, although the relative proportion of the body parts and sexual development remain unaffected. When hGH hypersecretion occurs during adulthood, acromegaly results. Acromegaly is a chronic, disfiguring, life-shortening disease characterized by the overgrowth of bones and soft tissues and cardiac dysfunction. Etiology The hypersecretion of hGH that produces gigantism and acromegaly is typically due to benign, slow-growing glandular tumors, or adenomas, in the anterior pituitary. Not subject to normal control, these neoplastic cells release abnormally high l...
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