Goiter
- 2. intro • is swelling of neck due to enlarged thyroid gland • simple goiter is usually not cancer • toxic goiter is enlarged thyroid with small , rounded growth • can occur in hyperthyroidism, hypothyroidism & normal thyroid function ( euthyroidism) • in goitre thyroid may functioning properly or not
- 3. types • endemic - due to iodine defi • sporadic - individual is affected ( age > 40 , F/H , F> M)
- 4. morphology ac to size • class 1 - palpation struma ( can't be seen only found by palpation) • class 2 - struma is palpative & can b seen easily • class 3 - struma is very large & retrosternal, pressure results in compressive marks
- 5. morphology ac to growth pattern • uninodular ( struma uninodulosa) may b inactive or toxic nodule • multinodular ( struma nodosa) - toxic • diffuse (struma diffuse) - whole thyroid is enlarged
- 6. thyroid nodules - two types • hot or warm - 15% , hyperthyroidism, low CA risk • cold - 85% , 20% of these r CA
- 7. Thyroid CA - risk factors • ch goiter • F/H • F> M • radiation exposure
- 8. causes • Iodine deficiency 90%(increased size of thyroid may be permanent if untreated for around five years) • Congenital hypothyroidism Inborn errors of thyroid hormone synthesis Hypothyroidism • Goitrogen ingestion • iodine neutralizing food ( cabbage, cauliflower, broccoli) • soyabean
- 9. gen symptoms • enlarged thyroid gland • breathing & swallowing difficulty due to pressure on trachea & esophagus respectively • cough • hoarsness
- 10. sign & symptoms • if due to hyperthyroidism (due to adrenergic stimulation) - tachycardia, palpitations, heat intolerance, hypermetabolism , wt loss, exophthalmos • if due to hypothyroidism - wt gain despite poor appetite, cold intolerance, lethargy , constipation
- 11. investigation • TSH • FT3 / R3 • FT4 / T4 • FT4I ( index) • ultrasound scan • FNAC • RAIU • thyroid antibody test
- 12. interpretation of lab value • high TSH & low FT4 /FT4I - primary hypothyroidism • low TSH & low FT4 / FT4I - hypothyroidism due to pituitary gland • low TSH & high FT4 /FT4I - hyperthyroidism
- 13. T3 test • to dx severity of hyperthyroidism • if hyperthyroidism - high T3 • high TSH & T3 but FT4 / FT4I is normal in some hyperthyroidism • rarely helpful in hyperthyroidism • pt can b severely hypothyroidism with high TSH & low FT4 / FT4I but T3 is normal • during preg & un women who r taking OCs T3 is high ( E increases binding proteins)
- 14. Thyroid antibody test • anti thyroid peroxidase & anti thyroglobulin antibodies • if hyperthyroidism & positive antibodies test then autoimmune thyroid disease • if hypothyroidism & positive antibodies test then hashimoto thyroiditis
- 15. thyroglobulin - Tg • doesnt measure thyroid function • doesnt dx thyroid cancer
- 16. RAIU - radioactive iodine uptake • T4 contains much iodine so thyroid must pull large amount of iodine to make T4 • pt has to swallow small amount of radioactive iodine • radioactivities track where iodine molecules go • if RAIU is high - hyperthyroidism • if RAIU is low - hypothyroidism
- 17. Rx • if hyperthyroidism - radioactive iodine to shrink gland • if iodine defi - lugol's iodineo or KI solution , seafood • if hypothyroidism - thyroxine replacement • benign nodules - shrunk or destroyed by radioactive iodine or Sx • in extreme cases like CA - partial or complete thyroidectomy & radioactive iodine
- 18. prognosis • good • goiter may disappeare or becomes larger • swelling stays if > 5 yrs