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GOITRE
Definition
Swelling in the thyroid gland
Endemic
Classification
Simple goitre
vDiffuse-physiological,pubertal,pregnancy
vMultinodular
Toxic goitre
vDiffuse eg.Graves' disease
vMultinodular
vToxic adenoma
Nontoxic goitre -caused by lithium or other
autoimmune diseases
Paradoxical goiter -enlarged thyroid as a result of
very high intakes of iodine
Occurs in Japan and China with high intake of
seaweed (50,000 - 80,000 mg/day)
Other classification
I -palpation struma - in normal posture of head it cannot be
seen,only on palpation
II-struma is palpative and can be easily seen
III-struma is very big and is retrosternal. Pressure and
compression marks
Incidence
Daily iodine requirement= 0.1- 0.15mg
Endemic goitre occur in geographical areas
with iodine-depleted soil, usually regions
away from the sea coast
Common in central Asia and central Africa ,certain
areas of Australia, including Tasmania and areas
along the Great Dividing Range
Goitre Belt
Etiology
?MC- iodine deficiency
In countries that use iodized salt, Hashimoto's thyroiditis
becomes the most common cause
?Hypothyroid
vCongenital hypothyroidism
vIngestion of goitrogens such as cassava
vSide-effects of pharmacological therapy
?Hyperthyroid
vGraves' disease
vThyroiditis (acute or chronic)
vThyroid cancer
Natural History
Growth stimulation
Diffuse hyperplasia
Active Inactive lobules
Vascular & hyperplastic Necrotic
Active follicles Inactive follicles
Symptoms
?Without any hormonal abnormalities, no symptoms
?Anterior neck mass
?Large masses compression of the local structure
?Difficulty in breathing /swal owing
?Toxic goitres present with
symptoms such as
palpitations, hyperactivity,
weight loss despite
increased appetite, and
heat intolerance
Tracheal Compression
Diagnosis
?Thyroid function test
?Chest X ray
?Ultrasound /CT Scan
?Needle Aspiration / Needle Biopsy
Treatment
?Antithyroid Medications: Propylthiouracil and
Methimazole
?I-131
?Surgical Therapy
Indications
?Cosmetic
?Pressure symptoms
?Patient anxiety
Types of thyroidectomy
All thyroid surgeries can be
assembled from three basic
elements
?Total lobectomy
?Isthmusectomy
?Subtotal lobectomy
Total thyroidectomy=
2 x total lobectomy+ Isthmusectomy
Subtotal thyroidectomy=
2 x subtotal lobectomy+ Isthmusectomy
Near-total thyroidectomy=
total lobectomy+ subtotal lobectomy+ Isthmusectomy
Lobectomy= total lobectomy+ Isthmusectomy
Steps of Thyroidectomy
?Exposure-horizontal neck incision, +/- raising of flaps, +/- division of
strap muscles
?Identification of structures -Recurrent and ext. branch of superior
laryngeal nerve, parathyroid glands
?Devascularisation
vSuperior thyroid artery
vInferior thyroid artery while protecting the supply to the parathyroids
vThyroid ima if present
?Resection
?Exploration of other pathology
?Closure
Gross and Microscopic Pathology
Multinodular Goiter
Potential complications after thyroid surgery
?Laryngeal Nerve Injury
?Parathyroid Deficit
?Postoperative Bleeding
?Infrequent Postoperative Complications
vSympathetic nerve injury- results in the development of Horner's
syndrome
vChylous fistula- damage to the thoracic duct
vThyroid storm-resulting from hyperactivity of the thyroid gland
hypoparathyroidism
Symptoms
vTingling in the lips, fingers, and toes
vDry hair, brittle nails, and dry, coarse skin
vMuscle cramps
vLoss of memory
vHeadaches
vSevere muscle spasms (also cal ed tetany)
vConvulsions
Treatment
vCalcium carbonate
vVitamin D supplements
?After sub total resection thyroxine is given to
suppress TSH secretion
?Radioactive iodine may reduce size of recurrent
nodular goitre
Prevention
? Introduction of Iodized salts
? Avoidance of goitrogens (cabbage, turnips,
peanuts, soybeans)
? In early (Hyperplastic) stage thyroxine 0.15-
0.2mg
? Most multinodular goitre are asymptomatic and
do not require surgery
This post was last modified on 08 April 2022