Subject: Medical Surgical Nursing Topic: Goiter for GNM, B.Sc.Nursing & P.B.B.Sc.Nursing students

1. GOITER

2. • It is an inflammation of the neck or larynx resulting from
enlargement of the thyroid gland.
• Abnormal enlargement of the butterfly-shaped gland below the
Adam's apple (thyroid).
• enlargement og the thyroid gland may be seen in both
hypothyroidism and hyperthyroidism.

3. • It generally result from a lack of iodine, inflammation, beging
or malignant tumor.
• A small goitre that doesn't cause symptoms may not need
treatment. In some cases, medication or surgery is required.
• More than 1 million cases per year (India).

7. There are 2 main types of goitre:
1.Diffuse goitre – where the entire thyroid gland swells and feels
smooth to the touch
2.Nodular goitre – where solid or fluid-filled lumps called
nodules develop within the thyroid and make the thyroid gland
feel lumpy to touch; the nodules can be single or multiple and
may contain fluid

9. 1. ENDEMIC GOITER
• Nutritional iodine deficincy
• Occurs during winter month
• Commonly develops in adolscents, pregnant woman and
nursing mothers.

10. 2. SPORATIC GOITER
• Genetic defect
• Faulty iodine metabolism
• Ingestion of large amount of nutritional goitrogens such
as cabage, soyabean, peanuts, peaches, strawberries,
spinach and radishes.
• Pitutary disease (Hypersecretion of TSH)

11. • Ingestion of medicinal goitrogens such as glucocorticoids,
dopamine, lithium, phenytoin, carbamazepine.
• Adverse drug reaction
• Autoimmune disease

12. If persons diet lacks in sufficient iodine or if production of
thyroid hormone is suppressed for any other reasons.
Thyroid gland enlarges to componsate hormonal deficiency.
Enlargement of gland also occurs in response to increased
pitutaty secretion of TSH

13. TSH stimulanes the thyroid to secret more T4 when blood T4
levels are decreased.
Thyroid gland become large.
Compresses structure in neck and chest.
Appearance of symptoms related to goiter.

14. • Coughing.
• A tight feeling in your throat.
• Changes to your voice, such as hoarseness.
• Difficulty swallowing (dysphagia)
• Difficulty breathing – there may be a high-pitched sound when
you breathe.

15. • History collection
• A thyroid function test is a type of blood test.
• Radioactive iodine scan
With this scan, a small amount of radioactive iodine is
injected into a vein in your arm.

16. The iodine builds up in your thyroid gland, which
can then be studied using a special camera.
The scan can provide useful information about the
structure and function of your thyroid gland.
As the amount of radiation used is very small, it's
perfectly safe for most people. But it may not be
suitable if you're pregnant.

17. • Ultrasound scan
build up a picture of the inside of your thyroid
gland
assess the size of your thyroid gland
check whether there are any enlarged nodules in
your thyroid gland not found during the physical
examination.

18. • Fine-needle aspiration
Fine-needle aspiration is a procedure where a
sample of the goitre is extracted so the cells inside
it can be tested.
The sample can be examined under a microscope to
determine what kind of cells are inside the goitre.

19. The treatment you receive will depend on:
• the size of the goitre.
• the symptoms the goitre is causing.
• whether you have any underlying thyroid condition.

20. MEDICAL MANAGEMENT
• A client is treated with preparations of iodine and thyroid hormone
• Iodine solutions or SSKI (Saturated Solution of Potassium Iodine)
drops can be administered.
• client diet containing higher amount of Iodine.
• dietary goitrogens should be avoided.
• adult requires atleast 50mg of iodine/day however 200-300mg is
considered the minimum adequate intake needed to prevent goiter.

21. SURGICAL MANAGEMENT
• Total Thyroidectomy :
Removal of total thyroid gland.
The client undergoing this surgery should be take thyroid hormone permentaly.
• Subtotal Thyroidectomy :
To correct simple goiter and hyperthyroidism.
here 5/6th gland is removed and 1/6th of functioning gland is let intact,
Hormone replacement may not be necessary.

22. • The risk of complications happening after thyroid gland surgery
is estimated to be 1 to 2 in 100.
• Infection
• Nerve damage : Permanent damage to the laryngeal nerves
affects 1 to 2 people in every 100 who have this type of surgery.

23. • Parathyroid gland damage : The parathyroid glands are tiny
glands behind the thyroid. They help regulate the amount of
calcium in your body.If the parathyroid glands are damaged
during thyroid surgery, you'll probably need to take calcium
supplements for the rest of your life.