Background: Goitre remains a high-signal global health indicator of thyroid dysfunction and population-level iodine status. Despite progress in salt iodization, early-stage thyroid enlargement is frequently under-detected in routine practice, especially when physical examination is confounded by body habitus and clinician subjectivity. Ultrasound is the preferred modality for early assessment, but interpretation is operator-dependent and increasingly burdened by rising thyroid nodule prevalence. Objective: This review synthesizes evidence on Machine Learning (ML) and Artificial Intelligence (AI) methods for predicting thyroid dysfunction and diagnosing early goitre (WHO Grade 1), with a practical emphasis on multi-modal “holistic AI” systems that combine tabular laboratory markers with imaging features. Methods: We summarize (i) supervised learning pipelines for structured clinical data (e.g., age, sex, TSH, T3, T4, T4U/FTI), (ii) deep learning architectures for ultrasound-based detection and segmentation (CNNs, U-Net variants, Vision Transformers), and (iii) deployment considerations including explainability, bias control, and reproducible benchmarking using open datasets. Following common clinical ML reporting practice, we emphasize confusion-matrixbased evaluation (precision/recall/F1/MCC) and strong ensemble baselines for tabular prediction. [30,31] Results: For tabular prediction tasks, stacked ensembles and gradient-boosted trees repeatedly rank among the best-performing approaches, particularly when combined with careful feature engineering and imbalance mitigation. For imaging, segmentation-first pipelines that estimate thyroid volume (e.g., U-Net family) and classification models leveraging multi-channel inputs or self-attention mechanisms (e.g., ViTs) report high diagnostic performance in differentiating benign enlargement from suspicious nodular patterns. Emerging smartphone-assisted workflows and LLM-based clinical summarization show promise for low-resource settings but require rigorous validation. Conclusion: AI can shift goitre management from late-stage detection to proactive screening by improving sensitivity for occult Grade 1 enlargement, standardizing ultrasound interpretation, and reducing unnecessary invasive procedures. Clinical adoption, however, depends on transparent explainability, external validation across diverse cohorts, and governance aligned with high-risk medical AI standards.