Differential Diagnosis of Goiter

Goiter detection depends on our recognizing thyroid enlargement, asymmetry, nodules, or abnormal consistency of the gland during physical examination. To determine if a child’s thyroid is enlarged, the World Health Organization (WHO) recommends using the subject’s thumb as a reference. Thyromegaly can be diagnosed if the lateral lobe of the thyroid is larger than the terminal phalanx of the child’s thumb. Careful palpation of the thyroid is required to detect localized or generalized changes in the consistency of the gland. A nodular goiter contains at least one cystic or solid lump having a different consistency from the rest of the gland. Recognizing that the entire gland has a firm consistency is important because this finding indicates the presence of thyroid disease (usually chronic lymphocytic thyroiditis) even in the absence of any enlargement.