Reconciling the grading system of goiter of yesteryears with that of World Health Organization of 1994

Reconciling the grading system of yesteryears with that of WHO on goiter.

The classification of goitre, used in the 80s of the 20th century, with regards to its size determined by palpation is the following:

Grade 0 – no goitre presence is found (the thyroid impalpable and invisible);
Grade 1a – the thyroid gland, however palpable, remains invisible, even in full extension of the neck (the thyroid not enlarged);
Grade 1b – goitre – palpable in normal position and visible in the upright position (full extension) of the neck; nodular goitres are also classified into this size range, even if they do not meet the criteria of enlarged thyroid gland;
Grade 2 – goitre – visible in normal position of the neck; no palpation required to diagnose thyroid enlargement;
Grade 3 – very large goitre, clearly visible from distance.

Delange F, Bastani S, Benmiloud M, De Maeyer E, Isayama MG, Koutras D, Muzzo S, Niepomniszcze H, Pandav CS, Riccabona G. Definitions of endemic goiter and cretinism, classification of goiter size and severity of endemias, and survey techniques.  In: Towards the Eradication of Endemic Goiter, Cretinism and Iodine Deficiency, (ed.)  Dunn JT, Pretell E, Daza GH, Viteri FE, Washington, PAHO Sci Publ 1986; 5:373 – 376.

The classification of goitre, as proposed by the WHO in 1994, refers to the following criteria:

Grade 0 – no goitre presence is found (the thyroid impalpable and invisible);
Grade 1 – neck thickening is present in result of enlarged thyroid, palpable, however, not visible in normal position of the neck; the thickened mass moves upwards during swallowing. Grade 1 includes also nodular goitre if thyroid enlargement remains invisible.
Grade 2 – neck swelling, visible when the neck is in normal position, corresponding to enlarged thyroid – found in palpation.

World Health Organization/UNICEF/International Council for the Control of Iodine Deficiency Disorders. Indicators for assessing iodine deficiency disorders and their control through salt iodization. Geneva: WHO/ NUT, 1994:94.6.

ROJoson’s TPOR:
Where there is no palpable thyroid enlargement or nodule, there is no goiter.  Grade 0 or normal thyroid.
When there is a palpable thyroid enlargement or nodule,
Not visible even with neck hyperextended, Grade 1
Is visible, regardless of position, Grade 2
The old classification added Grade 3, if goiter is huge and readily visible from a distance.
I prefer putting a Grade 3 for the huge one.
ROJ-TPOR@16aug3

 

 

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