Specimen photograph of total thyroidectomy from the patient seen in the previous photograph. The specimen measured 12 x 10 cm in size. The form most commonly seen in the United States is the sporadic goiter whose etiopathology is not clearly known. Cases of nodular goiter with a single dominant nodule can be difficult to distinguish clinically from a neoplastic process. Most patients with multinodular goiter are clinically euthyroid. Some cases may show hyperthyroidism; however, exophthalmos of diffuse hyperplasia (Graves disease) is not seen.