The thyroid disease GOITRE, Study notes of Clinical Medicine

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CLINICAL FEATURES AND

INVESTIGATIONS OF GOITER

• BY PRASHIL D. CHHATRALIYA ( 4 TH BHMS )

TYPES OF GOITER

1. Diffuse Simple Goiter or Diffuse Non-Toxic Goiter

2. Non-Toxic Multinodular Goiter

3. Toxic Multinodular Goiter

4. Hyperfunctioning Solitary Nodule or Toxic Adenoma

1. DIFFUSE SIMPLE GOITER

2. Laboratory Investigation :-

1. If the Patient have obstructive Sign and Symptoms , Respiratory flow measures , CT Scan and MRI To evaluate Sub sternal Goiter. 2.Thyroid Function Test :- In all Patients with Goiter , to evaluate Thyrotoxicosis or Hypothyroidism.

• In Iodine Deficiency , Total T4 = low , T3 and TSH = normal
• In Older Patients , Thyroid autonomy or Undiagnosed Graves Disease known as Subclinical Thyrotoxicosis , in which TSH = Low , T3 and T4 = normal

1. DIFFUSE SIMPLE GOITER

3. TPO Antibodies :-

• Useful to identify Patient at increase risk of Autoimmune Thyroid Disease.

4. Urine Iodine Level :-

• If low ( <50 micrograms/ Liter ) , suggest Iodine Deficiency.

5. Thyroid Scanning :-

• Generally not necessary , but it reveal Increased uptake in Iodine Deficiency or Dyshormogenesis.

6. USG :-

• Generally not indicated , in evaluation of Diffuse Goiter unless Palpable nodules examination.

2. NON-TOXIC MULTINODULAR GOITER

1) CLINICAL FEATURES :-

• Sudden Pain = by Haemorrhage into nodule.
• Hoarseness of Voice = reflected Laryngeal nerve involvement. Both things suggest Malignancy.

2. NON-TOXIC MULTINODULAR GOITER

2. Investigation :-

(A) Examination :-

• Thyroid architecture = Disturbed
• Tracheal Deviation = Due to compression
• Multiple nodules of various sizes are seen , some are Palpable , Some not. ☆ PEMBERTON’S SIGN

2. NON-TOXIC MULTINODULAR GOITER

(B) Investigation :-

4. Barium Swallow :-

• It reveal extent of Esophageal Compression.

5. USG :-

• To identify which nodule is biopsied in the basis of USG.

6. Nodule Biopsy :-

• For more suspicious nodules , where size is more than 1 cm.

3. TOXIC MULTINODULAR GOITER

1) CLINICAL FEATURES :-

• it includes Subclinical Hyperthyroidism or Mild Thyrotoxicosis.
• Usually elderly patients present with Atrial fibrillation , Palpitation , Tachycardia , weight loss , nervousness and tremor.
• Patient with recent exposure to Iodine , may precipitate or exacerbate Thyrotoxicosis.

3. TOXIC MULTINODULAR GOITER

2. Investigation :-

3. USG :-

• To assess the pressure of discrete nodule corresponding to areas of decrease uptake.
• If Nodule presents the ……

4. FNA :-

• Based on Sonographic frame and size FNA done.

4. HYPERFUNCTIONING SOLITARY NODULE OR TOXIC ADENOMA

1) CLINICAL FEATURES :-

• Usually mild
• Palpable single large thyroid nodule
• Absence of Clinical features suggests Graves disease or Thyrotoxicosis.