Goitre C010

Current RMA Instruments

Changes from previous Instruments

 ICD Coding

• ICD-10-AM Codes: E01.0, E01.1, E01.2, E04, E05.1, E05.2

Brief description

Goitre is an enlargement of the thyroid gland.  

Not all goitres are covered by this SOP:

• When goitre occurs as part of Graves disease or Hashimoto disease it is covered by the respective SOPs for those conditions. 
• When thyroid gland enlargement is due to thyroid cancer it is covered by the malignant neoplasm of the thyroid SOP.
• Congenital goitre and goitre due to hereditary defects in thyroid hormone synthesis (dyshormogenic goitre) are excluded from the SOP.
• Thyroid enlargement due to haemorrhage or infarction is also excluded from the SOP.

Otherwise, goitre, including goitre associated with normal, increased or decreased thyroid function (i.e. euthyroid, hyperthyroid/toxic or hypothryroid goitre) is covered by this SOP.

Confirming the diagnosis

The diagnosis is made on clinical grounds (finding an enlarged thyroid), or based on imaging evidence (e.g. thyroid ultrasound).  To apply this SOP further evidence will be needed to indicate the absence of Hashimoto thyroiditis, Graves disease, malignant neoplasm of the thyroid gland and other excluded conditions. 

Whether the goitre SOP, or the SOP for hypothyroidism, should be applied in cases where both an enlarged thyroid and decreased thyroid hormone function are present (and not due to one of the excluded conditions), will be a matter for judgement and medical advice.  Generally in such cases both the goitre and the decreased thyroid hormone will have a single cause (or the goitre will be a consequence of the hypothyroidism) and a single diagnostic label and determination will be appropriate.  The factors in the SOPs are nearly identical across the two SOPs so the choice of SOP will very rarely affect the outcome, but if it does, then the most beneficial SOP that is applicable should be used.  

The relevant medical specialist is an endocrinologist.

Additional diagnoses covered by SOP

• Adenoma of the thyroid
• Diffuse goitre (unless due to Graves disease)
• Goiter (US spelling)
• Goitre with hypothyroidism
• Goitre with hyperthyroidism
• Goitre with thyrotoxic crisis
• Nodular goitre
• Non-toxic uninodular or multinodular goitre
• Simple goitre
• Toxic uninodular or multinodular goitre

Conditions excluded from SOP

• Acute radiation thyroiditis^#
• Acute suppurative thyroiditis^# 
• Basedow disease* - Graves disease SOP
• De Quervain’s thyroiditis^# 
• Diffuse toxic goitre due to Graves disease* 
• Dyshormonogenic goitre^# 
• Graves disease*
• Haemorrhage or infarction of the thyroid gland^# 
• Hashimoto thyroiditis* 
• Malignant neoplasm of the thyroid gland*
• Riedel thyroiditis^# 
• Silent thyroiditis^# 
• Congenital goitre^#

* another SOP applies

^# non-SOP condition

Clinical onset

Most people with goitre have no symptoms (and normal thyoid function) and so the condition is first noticed at a medical examination or is found incidentally, e.g. after imaging performed for another reason.  Some cases will present with symptoms of abnormal thyroid function and the goitre will be found in the investigation of those symptoms.  In other cases the swelling in the neck may be noticed by the person or someone else.

Clinical worsening

Worsening would take the form of further enlargement of the thyroid, beyond the normal course of the condition.  Treatment for goitre is variable.  No active treatment may be required in some cases.