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Kidneys? No, just a big ol’ thyroid!

This is a post-thyroidectomy photo of a big mass of the thyroid gland! The patient presented with a massive neck mass - a multi modular goiter!! Generally, thyroid enlargement can be generalized and smooth, a so called diffuse goiter; or it can become larger due to growth of discrete lumps (nodules) within the gland, a nodular goiter, as seen above. A nontoxic multinodular goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. The incidence of goiter, diffuse and nodular, is very much dependent on the status of iodine intake of the population. In areas of iodine deficiency, goiter prevalence can be high and especially in goiters of longstanding, multinodularity develops frequently. Initially, uniform follicular epithelial hyperplasia (diffuse goiter) is present, with an increase in thyroid mass. As the disorder persists, the thyroid architecture loses uniformity, with the development of areas of involution and fibrosis interspersed with areas of focal hyperplasia. This process results in multiple nodules (multinodular or adenomatous goiter). The normal thyroid gland is a fairly homogenous structure, but nodules often form within its substance. These nodules may be only the growth and fusion of localized colloid-filled follicles, or more or less discrete adenomas, or cysts. Nodules larger than cm may be detected clinically by palpation. Nodules less than cm in diameter not clinically detectable unless located on the surface of the gland, are much more frequent. Diagnosis of a goiter is made at the time of a physical examination. One or more discrete nodules may be palpable. Once detected, the diagnostic evaluation is aimed at assessment of its size and the presence of nodules, identifying whether there are compressive or obstructive symptoms, assessing thyroid function, and identifying the underlying cause. This patient underwent a total thyroidectomy to treat his benign nodular goiter. Photo @mohamed.bayomi