Patient presents with complaints concerning thyroid enlargement, also known as goiter.  Symptoms include noticeable neck swelling, dysphagia, dyspnea, and a sensation of tightness in the throat.  Physical examination reveals a palpable, possibly multinodular, thyroid gland.  The thyroid enlargement is graded as (specify grade based on WHO or other accepted criteria, e.g., Grade 1, Grade 2).  Differential diagnosis includes simple goiter, multinodular goiter, thyroid cyst, thyroid adenoma, and thyroid carcinoma.  Further investigation is required to determine the etiology of the thyroid enlargement.  Initial laboratory tests ordered include thyroid stimulating hormone (TSH), free T4 (thyroxine), free T3 (triiodothyronine), and thyroid peroxidase antibodies (TPOAb).  Thyroid ultrasound is scheduled to assess the size, shape, and composition of the thyroid gland, and to identify any nodules or other abnormalities.  Depending on the ultrasound findings, fine-needle aspiration biopsy (FNAB) may be considered.  Patient education provided on thyroid disorders, potential causes of goiter, and the importance of follow-up care.  Treatment plan will be determined based on the results of the diagnostic tests and may include medical management with thyroid hormone replacement therapy, radioactive iodine therapy, or surgical intervention such as thyroidectomy.  Patient understands the need for ongoing monitoring and agrees to return for follow-up in (specify timeframe, e.g., 4 weeks) to review results and discuss further management options.  ICD-10 code E04.9 (unspecified nontoxic goiter) is provisionally assigned, pending definitive diagnosis.  CPT codes for the evaluation and management, laboratory tests, ultrasound, and potential FNAB will be documented upon completion of the procedures.