This document discusses different types of goiters including diffuse, nodular, hyperthyroid, and neoplastic goiters. It describes the causes of goiters such as iodine deficiency, dyshormonogenesis, and goitrogens. Evaluation of goiters involves assessing thyroid function tests, ultrasound characteristics, and fine needle aspiration cytology. Surgical treatment options for goiters include hemithyroidectomy, total/completion thyroidectomy, and management of substernal goiters.

1. By
s.Gayathri

2. GOITRE
DIFFUSE
EUTHYROID HYPOTHYROID
NODULAR
HYPERTHYROID

3. •Diffuse hyperplastic
•multinodular
Simple goitre
(euthyroid)
•Diffuse ( Graves disease)
•multinodular
Toxic
•Benign
•malignant
Neoplastic

4.  Autoimmune: chronic lymphocytic
thyroiditis, hashimoto’s throiditis
 Granulomatous: de quervain’s
thyroiditis
 Fibrosing: riedels’ thyroidits
 Infective
 others

5. SOLITARY NODULAR GOITRE DIFFUSE THYROID ENLARGEMENT

7. Iodine deficiency
Dyshormonogenesis
Goitrogens

9. Diiffuse hyperplasia of all lobules composed of active
follicles and uniform iodine uptake
Fluctuating stimulation..
Areas of active and inactive lobules
Active lobules more vascular
and hyperplastic

10. Haemorrhage causes cental necrosis leaving a rind
of active follicles
Necrotic lobules coalesce form nodules filled with
colloid or inactive follicles
Most nodules inactive. Active follicles only in
internodular tissue.

12.  Pt is either euthyroid, hypothyroid or
hyperthyroid.
 Papable smooth, firm or hard..
 Painless moves freely on swallowing
 Hardness and irregularity- calcification
 Painful nodule, sudden enlargement-
haemorrhage into simple nodule….

13.  Isolated or solitary( 70%)
 Dominant (30%)

14. SECONDARY THYROTOXICOSIS
PRESSURE SYMPTOMS
CARCINOMA ( follicular)

16. • SERUM TSH
• Free t3 and t4
THROID
FUNCTION
• Subclinical nodularity, cyst
• Microcalcification, inc vascularity, nodal
involvement
ULTRA
SONOGRAPHY
• Colloid nodules, thyroiditis, papillary,
• Medullary, anaplastic carcinoma , lymphoma
FNAC

17. Thy1 Non-diagnostic
Thy1c Non-diagnostic cystic
Thy2 Non-neoplastic
Thy3 Follicular
Thy4 Suspicious of malignancy
Thy5 Malignant

18. •Hashimotos
•Chronic lymphocytic thyroiditis
AUTOANTIBODY
TITRE
•TOXICITY+ NODULARITY
•Hot, warm, cold nodule
ISOTOPE SCAN
•Chest radiograph, CT, MRI
•Laryngoscopy, core biopsy
OTHERS

20.  Indication: Risk of neoplasia (FNAC Thy 3-5)
Symptomatic swelling ( age & sex)
Pressure symptoms. ( hoarseness
of voice)
Lymphadenopathy
Recurrent cyst
Cosmesis

21. Dominant nodule of
multinodular goitre
Subtotal thyroidectomy.. (inc
chances of recurrence)
Prefer total thyroidectomy (
also for FNAC thy 3-5)

22. HEMI
THYRIDECTO
MY
BIOPSY-
FOLLICULAR
CARCINOMA
TOTAL/COMP
LETION
THYROIDECT
OMY

23.  Extension of lower pole of nodular goitre
 Rare – from ectopic thyroid tissue.
 TYPES: substernal, plunging,intrathoracic
 SYMPTOMS:
 Dyspnoea with cough & stridor
 Dysphagia
 Engorgement of facial, neck & sup chest wall
veins. ( SVC obstruction) pemberton sign +

24.  INVESTIGATION:
 CHEST XRAY: - superior mediastinal shadow
-Deviation, compression of
trachea
DIAGNOSTIC: CT SCAN
Flow volume loop pulmonary function test
TREATMENT: total thyroidectomy sometimes
by median sternotomy approach

25. THANK
YOU