This document discusses different types of goiter (enlargement of the thyroid gland), including simple (non-toxic) goiter, toxic goiter, neoplastic goiter, and inflammatory goiter. It describes the causes, appearances, and effects of each type. Investigation methods and treatment options are also summarized, including medications, radioactive iodine, and surgical procedures for thyroid conditions.

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)