ROJoson PEP Talk: GOITER Management - Part 1 - Fundamentals and Generalities Contents: What is a goiter? What are the different types of goiter? What are the causes of goiter? How common are the goiters?

1. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 1.
Health
Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 1
February 5, 2022
1400H - 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 1.
Health
Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 1
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

3. There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.

4. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

5. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 1.
Health
Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 1
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
GOITER, Part 1. This
is part of the Health
Disorder Course.

6. Contents:
• What is a goiter?
• What are the common types of goiter?
• What are the causes of goiter?
• How common are the goiters?
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter

7. Contents:
• Clinical diagnosis of goiter
• Paraclinical diagnostic procedures for goiter
• Treatment for goiters
• Health restoration and maintenance
PART 2
PART 3
Fundamentals
and
Generalities in
Medical
Management
of Goiter

8. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Definition of Terms in Title AND Delimitation of
Coverage of Talk:
Fundamentals – simplest and essential facts and
theories which can serve as a basis or foundation
and support for advanced information
Generalities – general statements of info, not
covering specifics and details
Medical Management – diagnosis and treatment
by physicians

9. Fundamentals
and
Generalities in
Medical
Management
of Goiter
There are a lot of definitions given to the word
“goiter” that often leads to confusion among the
laypeople as well as the health professionals.
The definitions can be as the word “goiter” was
first used before and as it is used now.
What is a goiter?

10. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Allow me to clarify on the concepts of goiter used
by other people that have created confusion and
then allow me to give my 2-cents’ worth on the
concept of goiter that will be simple and of
practical usefulness in medical management.
What is a goiter?

11. Fundamentals
and
Generalities in
Medical
Management
of Goiter
First of all, goiter refers to something wrong with
the thyroid gland, a butterfly-shaped organ
located in the base and central part of the neck.
What is a goiter?

12. Fundamentals
and
Generalities in
Medical
Management
of Goiter
The thyroid gland is a vital organ (vital organ –
one that is needed to survive) that regulates
metabolism, growth and development of the
human body. The thyroid gland makes, releases,
and controls thyroid hormones that control
metabolism. Metabolism is a process where the
food taken into body is transformed into energy.
This energy is used throughout the entire body to
keep many of the body's systems working
correctly.
What is a goiter?

13. Fundamentals
and
Generalities in
Medical
Management
of Goiter
There are 2 concepts of goiter used by other
people.
One concept is the connotation that it is a benign,
not a malignant or not a cancer disorder of the
thyroid gland. The backstory here is that there
was a time iodine deficiency was a very common
cause of thyroid enlargement. Thus, this
connotation of “goiter” referring to iodine
deficiency goiter.
What is a goiter?

14. Fundamentals
and
Generalities in
Medical
Management
of Goiter
The other connotation is that goiter is an
enlargement of the thyroid gland. In the Internet,
the word “enlargement” is commonly used to
describe the presence of a goiter. “Enlargement”
has the connotation that the whole thyroid gland
is “enlarged” or increased in size without nodules.
What is a goiter?

15. Fundamentals
and
Generalities in
Medical
Management
of Goiter
In reality, the abnormalities in the size of the
thyroid that connote a goiter is present can be of
two types: “enlargement” and “nodule/s or
presence of nodule/s.” Both can present as an
abnormality of the thyroid gland or goiter but
they have different implications in terms of
possible causes.
What is a goiter?

16. Fundamentals
and
Generalities in
Medical
Management
of Goiter
At this point, my 2-cent’s worth is to just define
goiter loosely as any disorder in the thyroid gland.
What is a goiter?

17. Fundamentals
and
Generalities in
Medical
Management
of Goiter
I saw one site that defines a goiter as an “irregular
growth of the thyroid gland” (Mayo Clinic) rather
than “enlargement of the thyroid gland” to which
I initially prefer and appreciate. However, on a
second thought, I will just stick to “goiter as any
disorder in the thyroid gland” as not all goiters
will have irregular growth or any growth for that
matter. One can have a goiter in which there is no
physical growth of the thyroid gland and yet it is
producing abnormally high and abnormally low
levels of thyroid hormones.
What is a goiter?

18. Fundamentals
and
Generalities in
Medical
Management
of Goiter
To repeat, my 2-cents’ worth on the definition of
“goiter,” it is any disorder (a medical condition or
medical disease) in the thyroid gland.
A medical disease is a more specific term
compared to medical disorder. A medical disease
is characterized by specific symptoms and signs
that identify it as an abnormal entity in the body.
A medical disorder is any abnormality or
disruption in the normal structure and/or
functions of the body, not pinpointing to a
specific entity yet.
What is a goiter?

19. Fundamentals
and
Generalities in
Medical
Management
of Goiter
A goiter can be one that has diffuse
enlargement, nodule/s, or no changes in
the structure of the gland but there is
abnormality in the secretion of the thyroid
hormones.
A goiter can be benign or malignant (or
cancer).
What is a goiter?

20. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Goiter can be classified into several categories:
 By clinical presentation (diffuse or nodular
goiter; euthyroidism, hyperthyroidism,
hypothyroidism)
 By general categories of diseases (malignant vs
non-malignant disorders; hyperthyroidism vs
hypothyroidism)
 By names of specific disease
What are the different types of goiter?

21. Fundamentals
and
Generalities in
Medical
Management
of Goiter
By clinical presentation
The thyroid gland has both structure (the
butterfly-shape organ at the front, base and
center of the neck) and function (it secretes
thyroid hormones). It can have abnormality in
both structure and function, singly or in
combination.
What are the different types of goiter?

22. Fundamentals
and
Generalities in
Medical
Management
of Goiter
By clinical presentation
• Abnormality in function (hyperthyroidism or
hypothyroidism – normal: euthyroidism)
• Abnormality in structure (either enlargement
or nodule formation)
• Abnormality in both structure and function
(combined or simultaneous)
What are the different types of goiter?

23. Fundamentals
and
Generalities in
Medical
Management
of Goiter
• Goiter without structural abnormality (either
enlargement or nodule) but with over-
secretion or under-secretion of thyroid
hormones
• Goiter with structural abnormity (either
enlargement or nodule) but without over-
secretion or under-secretion of thyroid
hormones
• Goiter with structural abnormality (either
enlargement or nodule) and with over-
secretion or under-secretion of thyroid
hormones
What are the different types of goiter?

24. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Clinical Classification of Goiter:
• Diffuse toxic goiter (with diffuse enlargement
with hyperthyroidism)
• Diffuse non-toxic goiter (with diffuse
enlargement without hyperthyroidism – may
be euthyroidism or hypothyroidism)
• Nodular toxic goiter (with nodule/s with
hyperthyroidism)
• Nodular non-toxic goiter (with nodule/s
without hyperthyroidism may be euthyroidism
or hypothyroidism)
What are the different types of goiter?

25. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Definition of diffuse enlargement – the major
lobes of the thyroid glands such as the right and
left lobes are almost symmetrically enlarged or
increase in size and without nodule/s
Definition of nodules – presence of nodule /
nodules or lump/lumps / dominant mass/es
What are the different types of goiter?

26. Fundamentals
and
Generalities in
Medical
Management
of Goiter
By general categories of diseases
• Cancer and Not-cancer thyroid disorder or
goiter
• Hyperthyroidism and hypothyroidism
What are the different types of goiter?

27. Fundamentals
and
Generalities in
Medical
Management
of Goiter
By names of diseases as officially published in the
WHO ICD (International Classification of Diseases)
and as popularized by “thyroid experts” (which
may not jibe with each other)
What are the different types of goiter?

28. Fundamentals
and
Generalities in
Medical
Management
of Goiter
• Congenital iodine-deficiency syndrome
• Iodine-deficiency goiter
• Endemic Iodine-deficiency goiter
• Diffuse nontoxic goiter (diffuse colloid adenomatous
goiter)
• Nodular nontoxic goiter (colloid cyst; solitary colloid
adenomatous nodule; multiple colloid adenomatous
goiter)
What are the different types of goiter?

29. Fundamentals
and
Generalities in
Medical
Management
of Goiter
• Hyperthyroidism (Graves’ Disease)
• Hyperthyroidism (unspecified)
• Hypothyroidism
What are the different types of goiter?

30. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Thyroiditis
• Acute thyroiditis
• Subacute thyroiditis
• Chronic thyroiditis
What are the different types of goiter?

31. Fundamentals
and
Generalities in
Medical
Management
of Goiter
• Follicular adenoma
• Hurthle cell adenoma
What are the different types of goiter?

32. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Cancers
• Papillary thyroid carcinoma
• Follicular thyroid carcinoma
• Hurthle cell carcinoma
• Medullary thyroid carcinoma
• Anaplastic thyroid carcinoma
What are the different types of goiter?

33. Fundamentals
and
Generalities in
Medical
Management
of Goiter
ROJoson’s Simplified Categorization and
Classification of Common Types of Goiter
What are the different types of goiter?

34. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Clinical Classification of Goiter:
• DTG = Diffuse toxic goiter (with diffuse
enlargement with hyperthyroidism)
• DNTG = Diffuse non-toxic goiter (with diffuse
enlargement without hyperthyroidism – may
be euthyroidism or hypothyroidism)
• NTG = Nodular toxic goiter (with nodule/s with
hyperthyroidism)
• NNTG = Nodular non-toxic goiter (with
nodule/s without hyperthyroidism may be
euthyroidism or hypothyroidism)
What are the different types of goiter?

35. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Clinical Classification of Goiter:
Definition of diffuse enlargement – the major
lobes of the thyroid glands such as the right and
left lobes are almost symmetrically enlarged or
increase in size and without nodule/s
Definition of nodules – presence of nodule /
nodules or lump/lumps / dominant mass/es
What are the different types of goiter?

36. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Definition of diffuse enlargement – the major
lobes of the thyroid glands such as the right and
left lobes are almost symmetrically enlarged or
increase in size and without nodule/s
What are the different types of goiter?

37. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Definition of nodules – presence of nodule /
nodules or lump/lumps / dominant mass/es
What are the different types of goiter?

38. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Diffuse Goiter vs Nodular Goiter
What are the different types of goiter?

39. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Diffuse enlargement – Hyperthyroidism, hypothyroidism or
euthyroidism (depending on the associated symptoms and
signs)
Nodule formation – Malignant vs non-malignant disorders
What are the different types of goiter?

40. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Common diseases that I usually diagnose which
can be recognized clinically and relatively
common in the community:
• Hyperthyroidism (Graves’ Disease)
• Hyperthyroidism (unspecified)
• Hypothyroidism
• Acute thyroiditis
• Chronic thyroiditis
What are the different types of goiter?

41. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Common diseases that I usually diagnose which
can be recognized clinically and relatively
common in the community:
Malignant nodules or thyroid cancers:
• Papillary carcinoma
• Follicular carcinoma
• Anaplastic carcinoma
• Medullary carcinoma
What are the different types of goiter?

42. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Common diseases that I usually diagnose which
can be recognized clinically and relatively
common in the community:
Non-malignant nodules or conditions:
• Colloid cyst
• Colloid adenomatous nodule
• Multiple colloid adenomatous goiter
• *Diffuse colloid adenomatous goiter
What are the different types of goiter?

43. Fundamentals
and
Generalities in
Medical
Management
of Goiter
NOTE:
Currently, from the past up to now, there are no
uniform answers or lists among physicians and
medical organizations on the different types of
goiter. Medical organizations have different
listings. Thyroid specialists have different listings.
Practicing physicians have different listings.
THIS CAUSES CONFUSIONS AMONG
MEDICAL PRACTITIONERS AND
PATIENTS.
What are the different types of goiter?

44. Fundamentals
and
Generalities in
Medical
Management
of Goiter
If there are different terminologies used, the
bottom lines to answer (for medical management
purpose) is to determine the following:
• whether the medical condition or medical
disease involving the thyroid is a disorder of
functions; a disorder of structure; or both.
• whether there is hyperthyroidism or
hypothyroidism or not.
• whether there is malignancy or not.
What are the different types of goiter?

45. Fundamentals
and
Generalities in
Medical
Management
of Goiter
In general, risk factors include:
• Genetic predisposition
• Environmental influence – like lack of
iodine intake; excessive exposure to
radiation to the neck; stress
NOTE: A lot of goiters havs NO definite
known cause.
What are the causes of goiter?

46. Fundamentals
and
Generalities in
Medical
Management
of Goiter
More specific causes for specific diseases:
• Iodine deficiency goiter – lack of iodine intake
• Colloid adenomatous goiter – physiologic and
degenerative condition
• Cancer – genetic mutation with genetic
predisposition and radiation exposure
• Chronic thyroiditis – autoimmune disease
• Acute thyroiditis – infection
• Hyperthyroidism – autoimmune disease
• Hypothyroidism – iodine deficiency, physiologic
What are the causes of goiter?

47. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Except for iodine deficiency goiter due to lack of
iodine intake which can be prevented, for the
other diseases, one, nobody can predict when
one is going to have a thyroid disease and two,
the causes are realistically difficult to identify and
to control.
Healthy lifestyle with adequate iodine intake is
the best bet against thyroid diseases. However,
there is a percentage that one cannot prevent a
thyroid disease from occurring even with a
healthy lifestyle.
What are the causes of goiter?

48. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Based on my personal experience in my medical
practice:
• More common are those with structural
abnormality compared to those with pure
functional abnormality such as
hyperthyroidism and hypothyroidism. (about
95% to 5%)
• More common are those with benign
conditions compared to malignant conditions.
(about 95% to 5%)
How common are the goiters?

49. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Based on my personal experience in my medical
practice:
• Iodine deficiency goiter – practically non-
existent anymore because of iodine intake and
iodine-fortification in foods
• Colloid adenomatous goiter – most common
(90%)
• Cancer (5%)
• Hyperthyroidism (3%)
• Chronic thyroiditis (1%)
• Hypothyroidism (1%)
How common are the goiters?

50. Contents:
• What is a goiter?
• What are the common types of goiter?
• What are the causes of goiter?
• How common are the goiters?
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Summary
Take Away

51. Contents:
• What is a goiter?
Any disorder of the thyroid gland.
Not referring exclusively to a benign disorder.
Not referring exclusively to diffuse enlargement
but include nodule or lump formation.
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Summary
Take Away

52. Contents:
• What are the common types of goiter?
So many types in terms of disorders in structure
and functions and in terms of specific diseases
Diffuse enlargement – hyperthyroidism,
hypothyroidism, and euthyroidism
Nodule or mass – benign and malignant mass
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Summary
Take Away

53. Contents:
• What are the causes of goiter?
In general, risk factors include:
• Genetic predisposition
• Environmental influence – like lack of iodine
intake; excessive exposure to radiation to the
neck; stress
NOTE: A lot of goiters has NO definite known
cause.
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Summary
Take Away

54. Contents:
• How common are the goiters?
Fortunately, majority are not cancers.
• Colloid adenomatous goiter – most common
(90%)
• Cancer (5%)
• Hyperthyroidism (3%)
• Chronic thyroiditis (1%)
• Hypothyroidism (1%)
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Summary
Take Away

55. Fundamentals
and
Generalities in
Medical
Management
of Goiter
Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on fundamentals and
generalities in medical management of
goiter.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of goiter.

56. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 1.
Health
Disorder
Course–
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 1