[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [General pathology](https://durgical.com/en/general-pathology/) › [Endocrine system](https://durgical.com/en/general-pathology/areas/endocrine/) › Goitre: diffuse and multinodular

# Goitre: diffuse and multinodular

- Lesion

A goitre is an enlarged thyroid. It usually grows because the gland struggles to make enough hormone, most often for lack of iodine.

Updated Nov 12, 2026

## Key points

- Mechanism: impaired hormone synthesis, then high TSH, then follicular hyperplasia, then enlargement.
- Endemic goitre: iodine deficiency; goitrogens (cassava, cabbage family) can add.
- Two stages: hyperplastic (tall cells, little colloid) and colloid involution (flat cells, abundant colloid).
- Multinodular goitre: irregular nodules with haemorrhage, fibrosis, calcification and cystic change.
- Toxic multinodular goitre (Plummer disease): autonomous nodules, hyperthyroidism without eye disease.
- Most patients are euthyroid; problems are cosmetic, compressive or a nodule that mimics cancer.

## What it is

Goitre is the commonest thyroid disease. When hormone synthesis is impaired, TSH rises and drives follicular hyperplasia; over time cycles of hyperplasia and involution turn a diffuse goitre into a nodular one. Endemic goitre reflects dietary iodine deficiency in mountainous inland regions, including parts of the Andes; sporadic goitre is commoner in women and has many causes.

## Structure

- Diffuse goitre: symmetric enlargement; early, hyperplastic crowded cells; later, distended follicles with flattened cells and abundant colloid.
- Multinodular goitre: asymmetric, may weigh many times normal; nodules of colloid-rich follicles without a complete capsule.
- Secondary changes: old haemorrhage (haemosiderin), scarring, calcification, cysts.
- Substernal extension (plunging goitre) can compress the trachea or superior vena cava.

## Step by step

- Iodine deficiency or a synthesis defect lowers hormone output.
- TSH rises and stimulates follicular growth.
- Hyperplasia restores hormone at the price of a larger gland.
- Repeated cycles of stimulation and involution create heterogeneous nodules.
- Some nodules gain autonomy (often TSHR or GNAS mutations) and can make the patient thyrotoxic.

## Clinical notes

- Mass effects: dysphagia, airway compression, superior vena cava syndrome.
- A dominant nodule needs ultrasound and often fine-needle aspiration to exclude carcinoma.
- Colombia and the Andean countries: iodised salt sharply reduced endemic goitre.

## Memory aid

A goitre is the thyroid working overtime: when iodine runs short, TSH hires more cells, and over the years the factory grows lumpy.

## Test yourself

Think of the answer, then tap the question to see it.

## What drives thyroid enlargement in iodine deficiency?

Low hormone output raises TSH, which stimulates follicular cell hyperplasia and hypertrophy.

## What distinguishes toxic multinodular goitre from Graves disease?

Autonomous nodules cause the hyperthyroidism, there are no TSH-receptor antibodies, and there is no ophthalmopathy or dermopathy.

## Which secondary changes are typical of multinodular goitre?

Haemorrhage, haemosiderin, fibrosis, calcification and cystic degeneration.

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## Elsewhere in DurgiPedia

- [Thyroid hormone synthesis](https://durgical.com/en/biochemistry/pathways/thyroid-hormone-synthesis/)
- [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/)

## Connections

## Related 4

- [Hypothyroidism: causes](https://durgical.com/en/general-pathology/hypothyroidism-causes/)
- [Thyroid nodule and follicular adenoma](https://durgical.com/en/general-pathology/thyroid-nodule-and-follicular-adenoma/)
- [Thyrotoxicosis: causes](https://durgical.com/en/general-pathology/thyrotoxicosis-causes/)
- [Hyperplasia: physiologic and pathologic](https://durgical.com/en/general-pathology/hyperplasia-physiologic-and-pathologic/)

## Related conditions 3

- [Goitre](https://durgical.com/en/conditions/goitre/)
- [Thyroid nodule](https://durgical.com/en/conditions/thyroid-nodule/)
- [Hypothyroidism](https://durgical.com/en/conditions/hypothyroidism/)

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Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.

Sources: [Goiter](https://www.ncbi.nlm.nih.gov/books/NBK562161/) (StatPearls (NCBI Bookshelf), 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/general-pathology/goitre-diffuse-and-multinodular/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/general-pathology/goitre-diffuse-and-multinodular/