GOITER

1. INTERNATIONAL SCHOOL OF
MEDICINE
NAME - Mrudula
Group -4th
SEM
9TH
GOITER

2. Goitre
Enlargement of thyroid gland.
Classification:
Simple (non-toxic) goitre.
Toxic goitre.
Neoplastic goitre.
Inflammatory goitre.

3. Simple (non-toxic) goitre
include:
simple hyperplastic goitre (colloid goiter)
Cause: -physiological in pregnancy, puberty
-iodine definiecy.
Appearance: Large, smooth firm, non-tendern
goitre
Effect: eythyroid & pressure effect.
Multinodular goitre.
Cause: presence of areas of hyperplasia & areas of
hypoplasia in gland.
Appearance: Large, irregular, nodular goiter
Effect: eythyroid & pressure effect.

4. Toxic goitre
Grave’s disease
Cause: Autoimmune disease characterizeby
presence of antibodies stimulate TSH
receptors in gland.
Appearance: Diffuce, nodular, hyperemic gland.
Effect: hyperthyroidism.
Toxic Multinodular goiter
(plummer’s disease)
Cause: Toxic effect of MNG
Appearance: Large, irregular, nodular goiter.
Effect: hyperthyroidism

5. Neoplastic goitre
Include:
-benign: adenoma
-malignant: papillary, follicular, anaplastic,
medullary and lymphoma
Cause: -complication of MNG.
-radiation
Appearance: Enlarged goiter associated with
lymphadenopathy
Effect: -pressure effect.
-euthyroid.
-invasive effect

6. Inflammatory goitre
Rediel’s thyroditis
Cause: Fibrosis of thyroid
Appearance: Enlarged stony hard thyroid
Effect: Pressure effect
De quervain’s thyroiditis
Cause: Viral infection
Appearance: Diffuse, firm, tender swelling
Effect: Mild hyperthyroidism
Hashimoto’s thyroiditis
Cause: Autoantibody against thyroid gland.
Appearance: Diffuse, enlarged, non-tender goitre
Effect: Hypothyroidism

7. Investigation:
Laboratory investigation:
-serum T3, T4.
-serum TSH.
-serum LATS:
in grave’s disease
-thyroid antibodies:
in hashimoto’s disease.
-serum cholesterol
increase cholesterol level in
hypothyroidism

8. Endoscopic investigation:
-bronchoscopy: show compression and infiltration of
trachea by tumer
Biopsy:
-fine needle aspiration biopsy.
-true-cut biopsy.

9. Medical Treatment
Antithyroid drugs:
e.g: carbimazole, propylthiouracil.
It use to treat hyperthyroidism
Mechanism:
Inhibit thyroid hormones synthesis by block iodine
organification and also PTU inhibit
conversation of T4 toT3
Side effect:
Drug rash
Lymphadenopathy
N/V
Agranulocytosis

10. Beta-adernergic blockers:
e.g: propranolol
it is control sympathetic over activty to control
cardiovascular feature.
Radioactive iodine:
Taken orally in solution
Given for 8-12 wks.
Use for recurrent hyperthyroidism
Contraindication:
Pregnant women
Nursing mothers.

11. Surgical treatment:
Indication:
Failure of medical treatment.
Drug sensitivity in young patients.
Large goiter with compression symptoms.
Malignancy.

12. Preoperative preparation:
Patient should become euthyroid before surgery to prevent thyroid crisis.
Assimment vocal cord condition.
Operation:
For solitary benign nodule: lobectomy.
For cancer: total thyroidectomy.
For thyrotoxicosis: subtotal thyroidectomy

13. Complication of operation:
Hemorrhage
Recurrent laryngeal nerve damage.
Superior laryngeal nerve damage
Hypoparathyrodism
Hypothyroidism
Septesis
Postoperative infection
Hypertrofic scaring (keloid)