Sunday, 21 October 2007

Goitre

Goitre


Symetrical enlargement of the thyroid galnd

Size (estimate e.g 5X5 cm)

Smooth/nodular surface, soft consistancy

Move with swallowing

The lower edge of the goitre is well demarcated

No briut

No palpable lymph node


Diffuse goitre:

Causes:

1-Simple goitre:
No clear cause for the enlargement
Physiological: puberty/pregnancy

2-Autoimmune thyroid disease:
Graves’s disease
Hashimoto’s thyroditis

3-Thyroditis:
De Queverian

4-Goiterogenes:
Lithium, iodide, sulphonylureas

5-Dyshormonogenesis

Investigations:

TFT

Thyriod scan


Note:

If there has been no recent rapid increase in size and the gland is cusing no symptoms or worrying the patient, there is no further Ix or Rx required.

Thyroid scan deferentiate between

Functional (hot) nodule

Non functionig (cold) nodule

Nodular goitre;

Multinodular goitre:

The most common, espcially old patiets

Causes:

1-Toxic multinodular goiter

2-simple multinodular goiter →Relative iodine deficiency


Solitary nodule:

Majority are cystic or benign

Malignancy should be cosidered in any soiltay nodule

Risk factor for malignancy;

-Prev irradiation

-Long standing idonie def

-Occasional familial cases


Investigations:

TFT if TSH ↓or undetectable→ thyroid scan

If TSH normal →USS+FNA


Traetment:

-Surgery

-Antithyroid medication

-Radioiodine

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    thyroid scan defferentiate between hot and cold nodule.hot nodule is rarely mailgnant but cold one's has 10% chance of malignancy.
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