​Pathology - Multinodular Goiter

​Pathology - Multinodular Goiter 
Typically originates from persistent, uncomplicated goiters, which may result from iodine shortage, goitrogens (such as calcium or fluorides), or deficiency in thyroid hormone biosynthesis enzymes.

Pathology: The thyroid gland shows asymmetrical, nodular hypertrophy.
Microscopic examination reveals individual nodules with colloid-rich follicles, follicular epithelial hyperplasia, and regions of hemorrhage, calcification, and fibrosis.

Clinical Symptoms 
Goiter often presents in euthyroid people, although some may have hyperthyroidism. Symptoms may include dysphagia or hoarseness caused by compression of nearby structures.

Treatment involves administering synthetic levothyroxine to patients who are euthyroid in order to control TSH levels and reduce hyperplasia.

A goiter can be either toxic, producing thyroid hormone (TH) and causing hyperthyroidism, or nontoxic, not producing TH.
A biopsy (FNA) is necessary for big irregular nodules to exclude the presence of cancer.