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.

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...
POLYCYSTIC OVARY SYNDROME ICD-9: 256.4 Description Polycystic ovary syndrome (PCOS) affects about 1 in 10 women in the United States and is a leading cause of infertility. Numerous cysts in the ovaries disrupt the monthly reproductive cycle, often causing irregular menstrual periods, excess hair growth, and obesity. Etiology While the cause is essentially unknown, in PCOS, the body produces an excess of androgens (usually produced in only small amounts by the ovaries), and the ratio of LH to FSH is abnormally high. Either ovulation occurs less frequently than the unsual 28-day cycle or the ovaries do not ovulate at all. This imbalance causes either a very irregular menstrual cycle or no menstrual cycle. There appears to be a connection between excess amounts of insulin produced in the islets of Langerhans and excess amounts of androgen production in the ovaries. It is possible, also, that PCOS is genetic in origin. Signs and Symptoms Women with PCOS usually have one or more of the following symp...
COMMON SYMPTOMS OF ENDOCRINE SYSTEM DISEASES AND DISORDERS Individuals may present with the following common symptoms that are often related to one or more diseases or disorders and deserve attention from health-care professionals: Mental abnormalities Unusual change in energy level Changes in skin, nails, or hair Muscle atrophy Growth abnormalities Polyuria or polydipsia Cold or heat intolerance Unusual weight gain or loss Nausea or vomiting Irregular menstruation Erectile dysfunction Carefully listen to what clients say about their symptoms, and do not make assumptions without careful consideration and proper diagnostics.
PANCREAS AND THE ISLETS OF LANGERHANS DISEASES AND DISORDERS The pancreas lies behind the stomach, in front of the spine, and is surrounded by the intestines and liver. The pancreas serves both as an endocrine gland and an exocrine gland. It secretes the hormones insulin and glucagon through a specialized cluster of pancreatic cells known as the islets of Langerhans. Alpha cells release glucagon that breaks down glycogen in the liver causing blood glucose levels to rise. Beta cells release insulin making it possible for cells to use blood glucose for energy. Type 1 and type 2 diabetes, the most common endocrine diseases of the pancreas, are the result of lack of insulin or insulin deficiencies.
HASHIMOTO THYROIDITIS ICD-9: 245.2 Description Hashimoto thyroiditis is the most common type of hypothyroidism. Inflammation of the thyroid gland also is known as autoimmune thyroiditis. The disease is chronic and more common in women than in men; it was first described by Dr. Hakaru Hashimoto in 1912. Etiology Autoimmune thyroiditis, a long-term inflammatory disease, is due to antibodies to thyroid antigens in the blood. When the inflammation causes lymphocytic infiltration, it is called Hashimoto thyroiditis. Myxedema and Graves disease are both linked to autoimmune thyroiditis. While the cause is essentially unknown, it is probably familial and may appear with other diseases, such as celiac disease and type 1 diabetes. Signs and Symptoms There may be moderate thyroid enlargement accompanied by pain and tenderness. Dysphagia may occur. The signs and symptoms are often subtle and mimic other disorders. They include fatigue and excessive sleepiness, depression, cold intolerance, and dry skin...