Does This Patient Have a Goiter?

CLINICAL SCENARIOS— HOW LARGE ARE THESE THYROID GLANDS? For each of the following patients, assessment of thyroid size is an important part of the clinical examination. In case 1, a 32-year-old woman presents with symptoms and findings consistent with hyperthyroidism, but she has no exophthalmos and has always been anxious. In case 2, a 55-year-old man has a diagnosis of Graves' disease, and the choice is made for radioactive iodine ablation therapy. In case 3, a 64-year-old man has a goiter that causes discomfort on swallowing, and thyroxine is to be administered in an attempt to shrink the thyroid gland. WHY ASSESS THE THYROID GLAND FOR SIZE? A goiter is simply an enlargement of the thyroid gland and may result from hormonal or immunological stimulation of gland growth or the presence of inflammatory, proliferative, infiltrative, or metabolic disorders (Table 1). A common error among those first learning about the thyroid