ROJoson PEP Talk: GOITER Management Part 3 - Fundamentals and Generalities Contents: Treatment for Goiters Health Restoration and Maintenance

1. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 3.
Health
Disorder
Course –
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 3

2. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 3.
Health
Disorder
Course –
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 3
February 19, 2022
1400H - 1500H
Via Zoom

3. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 3.
Health
Disorder
Course –
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 3
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.

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

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

6. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 3.
Health
Disorder
Course –
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 3
My PEP TALK today
is entitled:
Fundamentals and
Generalities in
Medical
Management of
GOITER, Part 3. This
is part of the Health
Disorder Course.

7. Contents:
• What is a goiter?
• What are the common types of goiter?
• What are the causes of goiter?
• How common are the goiters?
• Clinical diagnosis of goiter
• Paraclinical diagnostic procedures for goiter
PART 1
Fundamentals
and
Generalities in
Medical
Management
of Goiter
PART 2

8. Contents:
• Treatment for goiters
• Health restoration and maintenance
PART 3
Fundamentals
and
Generalities in
Medical
Management
of Goiter

9. 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
Fundamentals
and
Generalities in
Medical
Management
of Goiter

10. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter

11. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Formulation of treatment plan starts with the
pretreatment diagnosis.
There must be a pretreatment diagnosis that is as
specific as possible to serve as the basis for the
plan.
Must have
- name of the disease causing the goiter (or the
name of the thyroid disease)
- extent of the disease, example, the stage of a
thyroid cancer

12. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter
After formulating the pretreatment diagnosis,
including determining the extent of the disease
and other factors with effect on treatment,
first thing to do before considering and comparing
the options of treatment methods or modalities is
to spell out the specific objective or goal of
treatment:
For cancers: whether curative or palliative.
For non-cancers: whether curative or just control

13. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Procedures Benefit
(goal of
treatment)
Risk Cost Availability
Option1
Option2
Option3
After the physician
has decided on the
goal of treatment, he
gives or lists the
various options of
treatment and then
gives data on the
BRCA.
With the data given,
the patient is asked
what s/he prefers.

14. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 greatest survival rate acceptable 5000 available
Option2 rate < 1 > 3 acceptable 6000 available
Option3 least survival rate acceptable 3000 available
Example of BRCA
comparative analysis
of treatment
procedures

15. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 Lowest recurrence rate acceptable 5000 available
Option2 rate < 1 > 3 acceptable 6000 available
Option3 Highest recurrence rate acceptable 3000 available
Example of BRCA
comparative analysis
of treatment
procedures

16. Treatment for Goiter
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Example of BRCA
comparative analysis
of treatment
procedures
Procedures Benefit (goal of
treatment)
Risk Cost (PhP) Availability
Option1 most effective acceptable 2000 available
Option2 effectivity <1 >3 acceptable 3000 available
Option3 least effective acceptable 4000 available

17. Treatment for Thyroid Cancer
Fundamentals
and
Generalities in
Medical
Management
of Goiter
The usual goals of thyroid cancer treatment
include
• eradicating known tumors / cancers entirely,
preventing the recurrence or spread of the
primary cancer, and
• relieving symptoms if all reasonable curative
approaches have been exhausted.
Curative goal
Palliative goal

18. Treatment for Thyroid Cancers
Fundamentals
and
Generalities in
Medical
Management
of Goiter
At the time of treatment, a patient may present in
a cancer stage in which the goal is at best
palliative only (relieving symptoms). These are
usually the patients with advanced cancers.
For patients presenting with early staged cancers,
the goal is curative that is, eradicating the tumors
/ cancers entirely and preventing the recurrence
or spread of the primary cancer.
Thus, objective of
treatment is primarily
dependent on the
stage or extent of
cancer at the time of
treatment.

19. Treatment for Thyroid Cancers
Fundamentals
and
Generalities in
Medical
Management
of Goiter
4 common types of thyroid cancers
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma
For curative goal:
• Primary treatment modality: OPERATION
• May be followed by radioactive iodine
therapy
• May be followed by medical suppressive
therapy using levothyroxine
For palliative goal:
• Chemotherapy
• Radiation therapy

20. Treatment for Thyroid Cancers
Fundamentals
and
Generalities in
Medical
Management
of Goiter
4 common types of thyroid cancers
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma OPERATIONS:
• Thyroidectomy (subtotal / total)
• Neck dissection (different kinds)

21. Treatment for Non-Cancer Goiters
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Goiters with functional disorders
• Hyperthyroidism
• Hypothyroidism
Goiters with non-functional disorders and benign
conditions
• Colloid adenomatous goiters
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!

22. Treatment for HYPOTHYROIDISM
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Medical therapy (NO OPERATION as this will
aggravate the hypothyroidism)
Replacement therapy – thyroid hormones, usually
levothyroxine – usually lifetime!
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!

23. Treatment for HYPERTHYROIDISM
Fundamentals
and
Generalities in
Medical
Management
of Goiter
3 options for goiters that are small to moderate in
size:
• Medical therapy with anti-thyroid drugs
• Operative therapy
• Radioactive iodine therapy
For huge-size goiters, operative therapy is
recommended!
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!

24. Treatment for COLLOID ADENOMATOUS
GOITERS
Fundamentals
and
Generalities in
Medical
Management
of Goiter
4 categories:
• Diffuse colloid adenomatous goiter
• Colloid cyst
• Solitary colloid adenomatous goiter or nodule
• Multiple colloid adenomatous goiter
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!

25. Treatment for COLLOID ADENOMATOUS
GOITERS
Fundamentals
and
Generalities in
Medical
Management
of Goiter
4 categories:
• Diffuse colloid adenomatous goiter
• Colloid cyst
• Solitary colloid adenomatous goiter or nodule
• Multiple colloid adenomatous goiter
Options:
• Monitor without
meds
• Meds (levothyroxine)
• Operation
• Operation is
recommended for
huge-size goiter.
• Small to moderate
ones, no operation
(monitor without
meds or with meds)

26. Treatment for Non-Cancer Goiters
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Goiters with functional disorders
• Hyperthyroidism
• Hypothyroidism
Goiters with non-functional disorders and benign
conditions
• Colloid adenomatous goiters
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
SURVEILLANCE OR
MONITORING NEEDED – LIFE
TIME!

27. Post Treatment Health Restoration and
Maintenance
Fundamentals
and
Generalities in
Medical
Management
of Goiter
After treatment for any type of goiter,
• Non-cancer goiters
• Cancer goiters (particularly)
there must be surveillance or follow-up or check-
up – usually lifetime – for recurrence.
Early detection of recurrence  early treatment
 better outcome!

28. Post Treatment Health Restoration and
Maintenance
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Patients may be taking maintenance meds for
control of disease – may be lifetime!
Patients are advised to have a healthy lifestyle to
promote health restoration and maintenance.
Except for ANAPLASTIC THYROID CA (fortunately
rare) and advanced cancers, the rest can still have
a long life after treatment.

29. CONTENTS:
Treatment for GOITERS
Health Restoration and Maintenance
Fundamentals
and
Generalities in
Medical
Management
of Goiter
Summary
Take Away
PART 3

30. 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.
Take Away in
relation to
Patient
Empowerment
Fundamentals
and
Generalities in
Medical
Management
of Goiter

31. Empowerment
objective - for
laypeople to have an
understanding of
the FUNDAMENTALS
and GENERALITIES in
the MEDICAL
MANAGEMENT of
GOITER – Part 3.
Health
Disorder
Course –
Fundamentals
and
Generalities in
Medical
Management
of Goiter –
Part 3