This document discusses bocio (goiter), including its definition, anatomy, pathophysiology, clinical presentation, diagnosis, classification, and treatment. Bocio is defined as enlargement of the thyroid gland and can be caused by biosynthetic defects or iodine deficiency. The thyroid gland is normally located in the lower front of the neck. Pathophysiologically, bocio can involve increased TSH levels stimulating thyroid growth as a compensatory mechanism. Bocio is classified into types including diffuse non-toxic goiter, multinodular non-toxic goiter, and multinodular toxic goiter. Diagnosis involves history, physical exam, laboratory tests, ultrasound, and scans. Treatment depends

1. Bocio
Guillermo Mora Oscar Samuel –
R1MF

2. definición
“Aumento del tamaño
de la glándula
tiroides”
Defectos de Biosíntesis
Deficiencia de Yodo
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2020). Harrison's
Principles of Internal Medicine (20th ed., pp. 2710 - 2718). New York: McGraw-Hill Professional

3. Anatomía

4. Glándula
Tiroides
Tamaño: 4-4.8 X 1-
1.8 X 0.8-1.6 cm
Volumen: 7 a 10 mL
Peso: 10 a 20
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2020). Harrison's
Principles of Internal Medicine (20th ed., pp. 2710 - 2718). New York: McGraw-Hill Professional

5. Glándula
Tiroides
Caudal a la
Laringe
Anterolateral
a la Tráquea
Esófago
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J.,
& Loscalzo, J. (2020). Harrison's Principles of Internal

6. ANATOMIA
Crecimiento
hacia afuera
Gran Tamaño
Agrandamiento
Asimétrico
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines for
patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

7. Fisiopatología

8. Fisiopatología
Biosí
ntesi
s
Yodo
Funci
ón
Tiroid
ea
Aumento de la TSH
Estimulación del
crecimiento de la
Glándula
Mecanismo
compensador
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

9. Fisiopatología
Graves
oEfectos de
inmunoglobulinas
estimulantes
oTSH – R
Hashimoto
oDefectos adquiridos de la
• Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., & Walter, M. A. (2016). 2016
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid : official journal of the American
Thyroid Association, 26(10), 1343–1421.

10. fisiopatología
Origen Genético
Volumen es proporcional
a la edad
Mas tiempo de evolución
= Mayor Tamaño
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S.,
McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines for patients with hyperthyroidism and
hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

11. Presentación
clínica

12. Presentación
Clínica
• ASINTOMATICOS
• Décadas
• Incidentales
• Síntomas
relacionados a la
disfunción
• Hipotiroidismo
Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman,
L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F.
(2015). Treatment guidelines for patients with hyperthyroidism and

13. Presentación Clínica
Bocio de Larga
Duración
Compresión de la
Tráquea
Crecimiento
repentino
• Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., & Walter, M. A. (2016). 2016
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid : official journal of the American
Thyroid Association, 26(10), 1343–1421.

14. Síntomas Obstructivos
Disnea
Estridor
Tos /
Disfonía
Disfagia
Apnea
Obstructiva
Sindrome de
Horner
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

15. Diagnostico

16. diagnostico
Hallazgo Incidental
Estudios de función
Tiroidea
Tamaño del Bocio
Síntomas
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S.,
McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines for patients with hyperthyroidism and
hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

17. Historia
Clínica
Enfermedad
Tiroidea
Preexistente
Deficiencia de
Yodo
Exposición a
Radiación
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., &
Loscalzo, J. (2020). Harrison's Principles of Internal Medicine (20th

18. Exploración
Física
• Inclinar la cabeza del
paciente hacia atrás
• Inspeccionar la región
bajo el cartílago cricoides
• Identificar el
contorno de la
glándula
• Observar al paciente
Bickley, L., Szilagyi, P., & Hoffman, R. (2018). Bates’ Guide
to Physical Examination and History Taking (12th ed., pp.

19. Técnica Posterior
•Colocar ambas manos
sobre el cuello del
paciente
•Pedirle que Degluta
•Percibir el Istmo Tiroideo
•Desplazar la tráquea
hacia los lados con la
Bickley, L., Szilagyi, P., & Hoffman, R. (2018). Bates’ Guide to Physical Examination and History Taking (12th ed., pp. 262 - 263). Philadelphia:

20. Laboratorio
o Perfil Tiroideo
o Anticuerpos
Anti-peroxidasa
o Anticuerpos
Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment

21. imagen
Radiografía
Ultrasonido
Crecimiento
Rápido
Asimetría
Consistencia
sospechosa / Dolor
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

22. ultrason
ido
SIGNOS DE
MALIGNIDA
D
Microcalcific
aciones
Adenopatías
Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman,
L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F.
(2015). Treatment guidelines for patients with hyperthyroidism and

23. Tomografía
Localizaciones
Cervicales y
Subesternales
Rastreo de Cuello y
Tórax
Tamaño Impreciso
• Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A. L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., & Walter, M. A. (2016). 2016
American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid : official journal of the American
Thyroid Association, 26(10), 1343–1421.

24. clasificación

25. BO
CI
• Bocio Difuso
No Toxico
• Bocio
Multinodular
No Toxico
• Bocio

26. Bocio difuso No
Toxico
Título de la presentación

27. Bocio difuso no toxico (simple)
Ausencia de Nódulos y
Disfunción Tiroidea
Deficiencia de Yodo
Bocio Endémico - >5%
de la población
Mujeres > Hombres
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines for
patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

28. Presentación Clínica
ASINTOMÁTIC
A
Aumento de
Tamaño
Simétrico
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines for
patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

29. tratamiento
Restitución de Yodo
Regresión Variable
Duración desde la aparición
y Fibrosis Concomitante
Cirugía
Síntomas Compresivos
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S.,
McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines for patients with hyperthyroidism and
hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

30. Bocio multinodular
no toxico

31. Bmn No
toxico
Nódulos de
Varios
Tamaños
Hombres >
Mujeres
Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W.,
Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., &
Nikolai, T. F. (2015). Treatment guidelines for patients with

32. Presentación Clínica
Variante
Sintomática
•Extraordinariame
nte Grandes
•Fibrosos
•Compresión
Dolor
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

33. Diagnostico
Múltiples
Nódulos
Diversos
Tamaños
Signo de
Pemberton
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

34. Tratamiento
Conservador
Supresión de T4
rara vez eficaz
Evitar Medios de
Contraste
Yodo Radioactivo
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

35. Bocio
Multinodular
Toxico

36. Presentación Clínica
Similar a BMN No
Toxico
Producción
Autónoma de
Hormona
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

37. Presentación
Clínica
o Pacientes Ancianos
o Trastornos del Ritmo
Cardiaco
o Nerviosismo / Temblor
o Perdida de Peso
Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2020). Harrison's Principles of Internal

38. Diagnostico
Perfil Tiroideo
TSH Baja
T3 > T4
Gammagrafía
Captación
Heterogénea
Múltiples Regiones
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment guidelines
for patients with hyperthyroidism and hypothyroidism. Standards of Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.

39. Tratamie
nto
Control de Los
Síntomas
• Betabloqueado
res
Antitiroideos
• Yodo
Radioactivo
• Metimazol
Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W.,
Braverman, L. E., Daniels, G., Greenspan, F. S., McDougall, I. R.,
& Nikolai, T. F. (2015). Treatment guidelines for patients with

40. Gracias
• Kasper, D., Fauci, A., Hauser, S., Longo, D., Jameson, J., & Loscalzo, J. (2020).
Harrison's Principles of Internal Medicine (20th ed., pp. 2710 - 2718). New York:
McGraw-Hill Professional Publishing.
• Singer, P. A., Cooper, D. S., Levy, E. G., Ladenson, P. W., Braverman, L. E.,
Daniels, G., Greenspan, F. S., McDougall, I. R., & Nikolai, T. F. (2015). Treatment
guidelines for patients with hyperthyroidism and hypothyroidism. Standards of
Care Committee, American Thyroid Association. JAMA, 273(10), 808–812.
• Ross, D. S., Burch, H. B., Cooper, D. S., Greenlee, M. C., Laurberg, P., Maia, A.
L., Rivkees, S. A., Samuels, M., Sosa, J. A., Stan, M. N., & Walter, M. A. (2016).
2016 American Thyroid Association Guidelines for Diagnosis and Management of
Hyperthyroidism and Other Causes of Thyrotoxicosis. Thyroid : official journal of