Diagnostic Imaging Pathways - Goitre (Investigation)
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Population Covered By The Guidance
This pathway provides guidance on the imaging of adult patients presenting with a goitre.
Date reviewed: July 2017
Date of next review: July 2020
Published: March 2018
Quick User Guide
Move the mouse cursor over the PINK text boxes inside the flow chart to bring up a pop up box with salient points.
Clicking on the PINK text box will bring up the full text.
The relative radiation level (RRL) of each imaging investigation is displayed in the pop up box.
| SYMBOL | RRL | EFFECTIVE DOSE RANGE |
 | None | 0 |
 | Minimal | < 1 millisieverts |
 | Low | 1-5 mSv |
 | Medium | 5-10 mSv |
 | High | >10 mSv |
Images
Image GalleryNote: These images open in a new page | ||
|---|---|---|
| 1a |  |
Retrosternal Goitre Image 1a, b, c and d (Computed Tomography): The right lobe of the thyroid is considerably enlarged with retrosternal extension and deviation of the trachea to the left (arrows). There are a few mediastinal nodes which measure around 1cm in short axis diameter. |
| 1b |  |
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| 1c |  |
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| 1d |  |
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| 2a |  |
Multinodular (Colloid) Goitre
Image 2a: Total thyroidectomy showing a multinodular goitre with marked asymmetrical enlargement of the right lobe due to a massive dominant nodule. |
| 2b |  |
Image 2b (H&E, x2.5): Histological section of a multinodular (colloid) goitre showing the usual features of variously sized, colloid-containing follicles lined by uniform epithelial cells, patchy areas of haemorrhage and fibrosis. |
| 2c |  |
Image 2c (H&E, x10): Histological section of Graves' disease showing hyperplastic follicles with infolding of the follicular epithelium to form papillary projections (blue arrow). The colloid is pale with scalloped margins (green arrows). |
Teaching Points
Teaching Points
- Common causes of goitre include autoimmune disease, thyroid nodules and iodine deficiency
- A detailed history is required initially in the assessment of a potential goitre
- If there is evidence on history or examination of potential thoracic outlet compression, a CT is required for further evaluation
- If there is no evidence of thoracic outlet compression, thyroid function tests determine the biochemical significance of the goitre and guide further diagnostic imaging
- Ultrasound is not routinely indicated in patients with a goitre but may be used to measure the volume of the thyroid gland and any response to treatment
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Computed Tomography (CT)
- Between 3% and 17% of goitres extend into the thorax, the majority being in the anterior mediastinum 1
- The use of contrast agents that contain iodine are best avoided because of the risk of inducing hyperthyroidism 2
- Although most patients are asymptomatic with an intrathoracic goitre, compression of the trachea may cause dyspnoea, wheezing or stridor 3, 4
- CT is generally considered the investigation of choice for the investigation of suspected intrathoracic goitre, particularly because of the limited availability of MRI 2, 3, 5
- Most mediastinal thyroid tissue retains a connection to the cervical thyroid gland so images of the neck should also be performed 6
- Before the administration of intravenous contrast, the attenuation of thyroid tissue exceeds that of other soft tissues of the neck and this characteristic helps distinguish thyroid masses from other types of mediastinal masses such as lymphoma 6
- After intravenous contrast administration thyroid tissue usually exhibits early and prolonged enhancement 6
References
References
Date of literature search: July 2017
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Mack E. Management of patients with substernal goiters. Surg Clin North Am. 1995;75(3):377-94. (Review article). View the reference
- Bin Saeedan M, Aljohani IM, Khushaim AO, Bukhari SQ, Elnaas ST. Thyroid computed tomography imaging: pictorial review of variable pathologies. Insights into Imaging. 2016;7(4):601-17. (Review article). View the reference
- Brennan M, French J. Thyroid lumps and bumps. Aust Fam Physician. 2007;36(7):531-6. (Review article). View the reference
- Hughes K, Eastman C. Goitre Causes, investigation and management. Australian Family Physician. 2012;41:572-6. (Review article). View the reference
- Sakkary MA, Abdelrahman AM, Mostafa AM, Abbas AA, Zedan MH. Retrosternal goiter: The need for thoracic approach based on CT findings: Surgeon’s view. Journal of the Egyptian National Cancer Institute. 2012;24(2):85-90. (Level III evidence). View the reference
- Glazer GM, Axel L, Moss AA. CT diagnosis of mediastinal thyroid. American Journal of Roentgenology. 1982;138(3):495-8. (Level IV evidence). View the reference
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