GOITER

PREPARED BY: FELIX KEVIN M. VILLA IV, RN

 Outlines:
Thyroid gland & mechanism
Goiter:
Definition
Classification
Causes
Symptoms
Risk factor
Tests and diagnosis
Treatments
Lifestyle
The thyroid is a small, butterfly- shaped gland inside
the neck, just below the Adams apple. The thyroid
gland produces hormones which control the bodys
metabolism and regulate the rate at which the body
carries out its functions
Definition:

A goiter is an abnormal enlargement

of the thyroid gland and can occur for
a number of different reasons.

.
Mortality/Morbidity:

Most goiters are benign, causing

only cosmetic disfigurement.

Morbidity or mortality may result from compression of

surrounding structures, thyroid cancer,
hyperthyroidism, or hypothyroidism.
Sex and age:

The female-to-male ratio is 4:1

In the Wickham study, 26% of women had a goiter,
compared to 7% of men.
Thyroid nodules are less frequent in men than in
women, but when found, they are more likely to be
malignant.
Classification:

Toxic goiter: A goiter that is associated with

hyperthyroidism is described as a toxic goiter.
Examples of toxic goiters include diffuse toxic
goiter (Graves disease), toxic multinodular goiter,
and toxic adenoma
Nontoxic goiter: A goiter without hyperthyroidism
orhypothyroidism is described as a nontoxic goiter. It
may be diffuse or multinodular
Examples of nontoxic goiters including goiter identified in
early Graves disease, congenital goiter, and physiologic
goiter that occurs during puberty
Other type of classification:
I - palpation struma - in normal posture of head it
cannot be seen. Only found when palpating.
II - struma is palpative and can be easily seen.
III - struma is very big and is retrosternal. Pressure
and compression marks.
Causes:
Worldwide, the most common cause for goiter is iodine
deficiency. In countries that use iodized salt,
Hashimoto's thyroiditis becomes the most common
cause.
- Excess iodine or lithium ingestion, which decrease release of thyro
hormone

-Goitrogens(cassava, lima beans, maize, bamboo shoots, and sweet

potatoes)
-Inborn errors of metabolism
causing defects in biosynthesis of
thyroid hormones

- Exposure to radiation

-Thyroid hormone resistance

 Side-effects of pharmacological therapy
such as:

Amiodarone :

inhibits peripheral conversion of thyroxine to

triiodothyronine; also interferes with

thyroid hormone action.

Phenobarbitone, phenytoin, carbamazepine,

Rifampcin:
induce metabolic degradation of T3 and T4.
Graves' disease

Thyroiditis

Thyroid cancer
Graves' disease

ones immune system produces a protein, called thyroid

stimulating immunoglobulin (TSI). As with TSH,
TSI stimulates the thyroid gland to enlarge
producing a goiter. However, TSI also stimulates
the thyroid to make too much thyroid hormone
(causes hyperthyroidism).
It can also affect the eyes, causing
bulging eyes (exophthalmos). It
affects other systems of the body,
including the skin, heart, circulation
and nervous system.
Thyroiditis:
it is the inflammation of the thyroid

gland.This disease is often considered a

malfunction of the immune system.

Antibodies that attack the thyroid are

what causes most types of thyroiditis.

It can also be caused by an infection,
like a virus or bacteria.
Hashimoto's thyroiditis:

This is a autoimmune condition in which there is

destruction of the thyroid gland by ones own
immune system.

As the gland becomes more damaged, it is less able to

make adequate supplies of thyroid hormone.
The pituitary gland senses a low thyroid hormone level
and secretes more TSH to stimulate the thyroid.
This stimulation causes the thyroid to grow, which
may produce a goiter.
Thyroid neoplasm or
thyroid cancer
usually
4 kinds of malignant tumors of the thyroid gland:
papillary, follicular, medullary or anaplastic
Symptoms:
In general:
-Swelling or disfigurement of the neck
-Afeeling of tightness in the throat
-Coughing
-Difficulty breathing
-Difficulty swallowing
Hyperthyroidism:

Weight loss, heat intolerance,

trembling hands, palpitations,
insomnia, anxiety,
increased bowel movement frequency.
Hypothyroidism:

Weight gain, cold intolerance,

constipation, very dry skin,

depressed mood, muscle cramping .

Symptoms of Possible
Cancer Spread:
Bone pain in one spot without relief

Weakness or numbness of an arm or leg

that persists .
Examination of the goiter is best performed with the
patient upright, sitting or standing. Inspection from
the side may better outline the thyroid profile, as
shown below. Asking the patient to take a sip of
water facilitates inspection. The thyroid should
move upon swallowing.
Palpation of the goiter is performed either facing the patient or
from behind the patient, with the neck relaxed and not
hyperextended.

Each lobe is palpated for size, consistency, nodules, and

tenderness. Cervical lymph nodes should be palpated.
Palpation of the goiter rules
out a pseudogoiter, which is
aprominent thyroid seen in
individuals who are thin.
 The pyramidal lobe often is enlarged in Graves disease.

A firm rubbery thyroid gland suggests

Hashimoto thyroiditis.

Multiple nodules may suggest a

multinodular goiter or Hashimoto
thyroiditis.
 A solitary hard nodule suggests
malignancy, whereas a solitary firm
nodule may be a thyroid cyst.
Diffuse thyroid tenderness suggests
subacute thyroiditis, and local thyroid tenderness suggests
intranodal
hemorrhage or necrosis.

Cervical lymph nodes are palpated for signs of metastatic

thyroid cancer
 Auscultation of a soft bruit over the inferior
thyroidal artery may be appreciated in a toxic
goiter. Palpation of a toxic goiter may reveal a thril.
Risk factor:

A lack of dietary iodine.

sex. Because women are more prone to thyroid

disorders than men
age. Being age 50 or older

Medical history. A personal or family history of

autoimmune disease
Pregnancy and menopause.

Certain medications.

immunosuppressants,

the heart drug amiodarone

and the psychiatric drug lithium

Radiation exposure.
Tests and diagnosis

Hormone test:
If the thyroid is overactive,the level of thyroid
hormone in the blood will be high and the level of
thyroid stimulating hormone (TSH) will be low
If the thyroid is underactive the level of thyroid
hormone will be low while the level of TSH will be
high.
Antibody test:
auto-immune antibodies.

Ultrasonography:
To show the size of the thyroid gland and the
presence of any nodules.
Fine needle aspiration
biopsy
Thyroid scan:
This scan will help evaluate the structure and
function of the thyroid and involves the
administration of radioactive substance.
Treatment:

Small benign euthyroid goiters do not require

treatment.just observe.

iodine supplementation by mouth

If hypothyroidism
thyroid hormone replacement with
levothyroxine(Levothroid,Synthroid)
aspirin or a corticosteroid
medication to treat the
inflammation.
Hyperthyroidism:
anti-thyroid drugs such as methimazole (Tapazole) or
propylthiouracil (PTU).
For advanced hyperthyroidism, radioactive iodine
treatment (RAI) .
Surgery

Large goiters with compression

Malignancy

When conventional drug therapy for overactive

thyroid is not successful
Lifestyle:
Get enough iodine(Sea vegetables,
Yogurt, cow's milk, eggs, and
strawberries )

The recommended minimum daily intake

of iodide is 150 mcg for adults, 220
mcg for pregnant women, and 290 mcg
for lactating women.

avoid excessive consumption.

Avoid Goitrogens (Foods that contain cyanoglucosides
include cassava, lima beans, maize, bamboo shoots,
and sweet potatoes.)