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Current RMA Instruments
|Reasonabel Hypothesis SOP||23 of 2013 as amended|
|Balance of Probabilities SOP||24 of 2013 as amended|
Changes from previous Instruments
- ICD-9-CM Codes: 240,241, 242.1-3, 226
- ICD-10-AM Codes: E01.0, E01.1, E01.2, E04, E05.1, E05.2
Goitre is an enlargement of the thyroid gland. Goitre may be associated with normal, increased or decreased thyroid function. Not all goitres are covered by this SOP. There are separate SOPs for Graves' disease and Hashimoto's thyroiditis (both common causes of goitre). Goitre may also be due to a malignant neoplasm (another separate SOP). There are also separate SOPs for hypothyroidism, and for hyperthyroidism and thyrotoxicosis.
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 show the absence of Hashimoto’s thyroiditis, Graves’ disease, malignant neoplasm of the thyroid gland and other excluded conditions. Whether the goitre SOP, or the SOP for either hypothyroidism, or hyperthyroidism and thyrotoxicosis should be applied, in cases where both an enlarged thyroid and abnormal thyroid 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 abnormal thyroid function will have a single cause and a single diagnostic label and determination will be appropriate. There are overlapping factors across the relevant SOPs so the choice of SOPs may not 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
- Goiter (US spelling)
- Non-toxic uninodular or multinodular goitre
- Simple goitre
- Toxic uninodular or multinodular goitre
Conditions excluded from SOP
- Acute radiation thyroiditis#
- Acute suppurative thyroiditis#
- Basedow’s disease* - Graves' disease SOP
- De Quervain’s thyroiditis#
- Diffuse toxic goitre* - Graves' disease SOP
- Dyshormonogenic goitre#
- Graves’ disease*
- Haemorrhage or infarction of the thyroid gland#
- Hashimoto’s thyroiditis*
- Malignant neoplasm of the thyroid gland*
- Riedel’s thyroiditis#
- Silent thyroiditis#
- Congenital goitre#
* another SOP applies
# non-SOP condition
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.
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.