Nodular goitre: structure, onset and sex distribution
THE CONTEXT
Simple goitre usually develops multiple nodules, although a single visible nodule may conceal widespread microscopic changes.
Nodule structure and degeneration
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Nodules are usually multiple, producing a multinodular goitre.
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Occasionally, only one macroscopic nodule is present despite microscopic changes throughout the gland; this is one form of a clinically solitary nodule.
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Nodules may be colloid or cellular. Cystic degeneration and haemorrhage are common, as is subsequent calcification.
Timing and distribution
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Nodules appear early in endemic goitre and between 20 and 30 years in sporadic goitre.
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Patients may remain unaware of the goitre until their late forties or fifties.
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All types of simple goitre are more common in females, attributed to oestrogen receptors in thyroid tissue.