What are some of the causes of this condition? What you do to diagnosis it? Will the Thyroid functions studies be abnormal? Would a needle aspiration help?

Causes are numerous, and range from iodine deficiency to hypothalamic and pituitary problems. In most people, there is no clear cut explanation. For the diagnosis, you must really combine history and physical with laboratory assessment. The anterior neck mass in the presence of an otherwise healthy person is the give away. The interesting thing with respect to thyroid function studies is that they are generally not way off the mark. The TSH may be elevated, but many times is in the reference range. Even the T4 and T3 values are generally about where they belong. In most cases, this represents a balanced or compensated situation. Finally, a fine needle aspiration is not going to be of much help here. All that will be retrieved will be normal looking thyroid follicular cells and colloid, which isn't going to distinguish this condition from much of anything. In these situations, a negative test adds no useful information. You might erroneously think that a negative benign result rules out the possibility of a malignancy, but not so. Do you know why?

Mark Braun, MD braunm@indiana.edu
Copyright 1998, the Trustees of Indiana University