Thyroid Disorder (1).pptx

seminar presentation on: Thyroid disorder/goiter
Prepared by: Tolosa Negussie
Yadeta kebeda
Derege Ayele
Geleto Hinika
Presented to: Mr Melese. (Asst professor )
Sep. 2023
SALALE UNIVERSITY COLLEGE OF
MEDICINE AND HEALTH SCIENCE
DEPARTMENT OF ADULT HEALTH
NURSING II
Thyroid disorders
Saturday, November 4, 2023 1

presentation Out line
 Case study
 Introduction
 Definition
 Etiology
 Pathophysiology and Clinical manifestation
 Diagnosis
 Management
 Summary
Saturday, November 4, 2023 Thyroid disorders 2

case study
• Name-Bekelech Bekele
• Age -35
• Sex-female
• Address- fitche

History
• Chief complaint- anterior neck swelling of four years
duration
• HPI-This is 35 years old female patient who presented
with complain of anterior neck swelling of four years
duration.
• On which she primarily noticed on her right lower neck.
The swelling was initially peen sized and it progressively
grows upward and medially.

History…
• Associated with this she feels shortness of breathe while
she walks a long distance and carry heavy objects.
• Otherwise she has no history of loss of appetite, weight
loss, and no history of weight gain
• No history of hot or cold intolerance
• No history of diarrhea

History…
• No history of drug intake
• No history of similar family illness and she reside
in fitche town
• No history of bone pain, yellowish discoloration
of skin, or contact with chronic cough

Physical examination
P/E
GA-healthy looking
• V/S-BP=89/61
PR=75
RR=18
T=ATT
SPO2=90
• HEENT-Pink conjunctiva and non icteric sclera
• LGS-Neck examination

Cont.…
• Inspection-there is visible round shaped anterior
neck swelling which moves with swallowing. It is
located centrally
• Palpation-there is 5x4cm non tender, nodular firm
swelling with regular border which is not attached to
underlying structure.
• Lowest tracheal ring is palpable above sternal
notch.

Laboratory investigation
 T3-6.11
 T4-23
 TSH-4.17
 FNAC-simple colloid goiter
Medical diagnosis-simple colloid goiter
Thyroidectomy was done for this purpose

Nursing diagnosis
 Acute pain related to postoperative edema as
evidenced by patient verbalization
 Risk for ineffective airway clearance related to
swelling
 Impaired verbal communication related tissue
edema as evidenced by nonverbal gestures

Nursing intervention
• Patient position of neck and head
• Instruct patient to use hand to support neck during
movement and to avoid hyperextension of neck
• Administer analgesics

Nursing intervention…
• Assess for dyspnea
• Assist with deep breathing exercise
• suction
• Check dressing frequently

Nursing intervention…
• Keep communication simple
• Provide alternative methods of
communication
• Maintain quite environment

Thyroid disorders
SIMPLE COLLOID GOITER

Introduction
Thyroid Gland
 Is the largest endocrine
gland in body
 Small butterfly shaped
gland located at base of
neck.
 Thyroid is controlled by the
hypothalamus and pituitary

Anatomy and physiology overview
Functions of Thyroid Gland
 Regulate the body’s overall basal metabolic rate
 Essential for normal growth & mental development
 Sexual maturation
 Controlling heart, muscle and digestive function
and bone maintenance

Anatomy and physiology overview…
Calcitonin
 Its produced from Para follicular C-cells
 It is secreted in response to high plasma levels of
calcium by:
 It increasing osteoblast and decreasing
osteoclast activity.
 Decreasing the calcium absorption from GIT
 Increasing urinary calcium excretion

Iodine
 Iodide is ingested in the diet, absorbed & its ions
are converted to iodine molecules.
 Molecules react with tyrosine (an amino acid) to
form the thyroid hormones.

Triiodotyronine(T3) and Tetraiodotyronine(T4)
 The synthesis of thyroid hormone is a complex
multistep process.
 Follicular cell transport iodide anion from the
blood to cytoplasm from blood stream.
 Iodide moves toward colloid stores and oxidized
to form neutral iodine two molecules.

Hormones: T4
 T4-thyroxine contains 4 iodine atoms
 It is a slow-acting pre-hormone
 T4 takes 4 days to peak in blood
 Half-life 7 days
 Overall effects take 6 weeks

Hormones: T3
 T3 is the active and faster-acting hormone
 The immediate effects of T3 last 1-2 days
 Half-life 1.5 days
 T3 is 10x more active than T 4

Hormones- TSH
 TSH is a pituitary hormone
 Controlled by TRH-thyrotropin releasing hormone
from hypothalamus
 Functions to stimulate thyroid hormone production
 May enlarge thyroid when under producing or
over producing

Thyroid Enlargement
• Diseases of the thyroid gland invariably leads to
enlargement of the gland.
• The term GOITER is applied to any
enlargement of the thyroid gland regardless of
the cause.

• The normal thyroid gland is impalpable. The term goitre
(from the Latin guttur = the throat) is used to describe
generalized enlargement of the thyroid gland.
• A discrete swelling (nodule) in one lobe with no palpable
abnormality elsewhere is termed an isolated (or solitary)
swelling.
• Discrete swellings with evidence of abnormality
elsewhere in the gland are termed dominant nodule.

SOLITARY NODULAR GOITRE DIFFUSE THYROID ENLARGEMENT

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

Causes of thyroid disease
inflammatory
Acute
Subacute
chronic
toxic
Primary
secondary
autoimmune
Hashimoto
Reidel thyroiditis
simple
Physiological
Colloidal
nodular
neoplastic
Benign
malignant

Simple colloid goiter
• Colloid goiter is defined as thyroid enlargement
without accompanying disturbance in thyroid
function.
• This is a common pathology, frequently found in
clinical practice during a physical or ultrasound
examination.

CONT…
• Colloid goiter is also known as endemic goiter,
simple goiter, nontoxic uninodular goiter,
nontoxic multinodular goiter or nodular
hyperplasia.
• They are benign lesions; however, on the
ultrasound image, they can mimic malignant
lesions.

Epidemiology
 It is a common disorder with prevalence ranges
from 2-15% population
 Female to male ratio = 10:1
 ↑ with age
 Mean age at diagnosis is 60 years

Iodine deficiency
Dyshormonogenesis
Goitrogens

Cont..
• An iodine-deficient diet is known to lead to
colloid nodular goiters.
• There is evidence that iodine supplementation
can decrease the incidence of goiter in these
people;

CONT…
• However, some cases of longstanding endemic
goiters do not always regress with iodine
supplementation.
• It has also been suggested that thyroid function
control factors, such as C cells, can alter iodine
levels, leading to goiter.

cont...
• A number of other possible factors leading to
colloidal goiter include; foods that block the
hormonal synthesis, mutations in thyroid-
stimulating hormone (TSH) receptors, globulin
stimulation of thyroid development, growth
hormone, insulin-like growth factor 1 (IGF-1) and
genetic factors.

CONT…
• Differential response to TSH leads to formation of
nodules within the gland.
• Several nodules may coalesce and lead to
formation of multinodular goiter.
• The nodules may undergo secondary changes;
central necrosis, cystic degeneration, hemorrhage,
calcification and malignant changes (3%).

Clinical presentation
• Gradual onset of painless anterior neck swelling,
usually long standing in endemically iodine deficient
areas.
• Recent onset of pain or increase in size may
indicate secondary changes.
• The enlarged gland may also affect neighboring
structures and lead to wide range of symptoms and
signs.

Clinical presentation
• Obstruction of airways
• Laryngeal nerve compression
• Esophageal obstruction
• Neck veins obstruction
• Superior vena cava syndrome
• (Pemberton’s sign).

Diagnostic Methods
• History and PE
• Anti TBO(TBOAb), Anti-Tg (TgAb), anti TSH
receptor (TRAb)
• T3, T4 & TSH
• Ultra Sound of neck
• MRI, CT- Scan

Treatment and prevention of simple
goiter
• Colloid goiter, as well as nontoxic goiter, usually
progresses slowly and is nosymptomatic;
therefore, it only requires follow-up, and not
treatment
• Medical treatment for nontoxic goiter is a matter
of debate, as it produces little or no results in
long-term goiters.

Treatment and prevention of simple
goiter
Dietary
• Iodine supplementation in iodine deficient
areas, food iodine fortification is one of the best
preventive measures of goiters.
Medical
• Thyroxin supplementation
• In patients with diffuse hyperplastic goiter for
several months (0.1 to 0.2mg per day).

Surgery indications
• In patients with obstructive symptoms,
• When malignancy is suspected clinically or after
FNAC,
• Hyper functioning nodules
• For cosmetic reasons

COMPLICATIONS
• Complications including hypoparathyroidism and
recurrent laryngeal nerve injury can occur during or
after thyroidectomy.
• Additionally, patients who undergo total
thyroidectomy require life-long thyroid supplements.
There are many algorithms for the diagnosis and
treatment of thyroid disease in general, and colloid
goitres in particular

Summery
 Colloid goitres are a common, benign lesion of the thyroid that
includes diffusion or a nodular pattern. They must be differentiated
from other causes of goitre, especially malignancy.
 Accurate diagnosis requires a general knowledge of the condition.
Patient history and physical examination, focusing on features
suggestive of malignancy, are very important in the initial evaluation.
 Thyroid ultrasound and serum thyrotropin are the main methods for
assessing colloid goitre and excluding other thyroid lesions.

Reference
 Harrison’s 21st edition,2022, principle of internal medicine,
Mcgraw-hill education, Vol.1
 Sabiston text book of Surgery 21th edition, 2020: the
Biological bases of modern surgical practice
• World Health Organization. International classification of
diseases for mortality and morbidity statistics (11th revision).
2018. Available at: https://icd.who.int/browse11/l-m/en
(accessed 17 September 2020).
• Alkabban F,, Patel B.. Nontoxic Goiter. In: StatPearls
[Internet]. Treasure Island: StatPearls Publishing; 2020.
• 42. Randolph GW,, Shin JJ,, Grillo HC,. et al. The surgical management
of goiter: Part II. Surgical treatment and results. Laryngoscope.
2011;121::68–76. [PubMed] [Google Scholar

THANK
YOU

Thyroid Disorder (1).pptx

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