Simple Goiter
Definition
It is a condition characterized by an enlargement of the thyroid gland without any dysfunction of the gland.
Aetiology
1.Physiological
.Puberty: Due to increased
demands.
.Pregnancy: Due to increased
demands.
2.Iodine
deficiency.
Clinical
features
1.There
is a uniform ,smooth enlargement of the thyroid gland .It is moderate.
2.The
goiter is on either side of the trachea or the neck.
3.It
moves up and down during swallowing.
4.There
may be respiratory difficulty if the goiter is very large and causes pressure
on the trachea. the respiration may be noisy.
Treatment
1.The
iodine deficiency is corrected by giving supplements.
2.When
it develops during the pregnancy or at puberty, thyroid hormone supplements are
given.
3.When
the goiter is large and is causing pressure effects or is cosmetically
disturbing, it is removed surgically (Partial thyroidectomy).
7.Toxic Goitre
Definition:
It is a
condition characterised by an enlargement of the thyroid gland associated with
thyrotoxicosis.
Aetiology
1.Age:15
to 30 years.
2.Sex:Male
<Female.
3.The
exact cause of this condition is not known.
Clinical features
1.There
is a uniform and smooth or irregular enlargement of the thyroid gland.
2.The
goiter is on either side of the trachea in the neck.
3.It
moves up and down during swallowing.
4.It is
fixed and cannot be moved easily.
5.Cervical
lymph nodes may be enlarged .They are hard and fixed.
6.Cervical
lymph nodes may be enlarged. They are hard and fixed.
7.There
may be features of thyrotoxicosis, such as the following:-
.Irritability, restlessness.
.Excessive appetite.
.Loss of weight despite adequate
food intake.
.Tachycardia at rest.
.Systolic blood pressure is
high.
.There is flushing of face.
.Atrial fibrillation may
develop.
.The eyes protrude(exophthalmos).
.Tremors are seen in
fingers and tongue.
.There is intolerance
to heat.
.Sweating is
excessive.
.Palms are warm and
moist.
.Nausea, vomiting, and
diarrhea may be present.
8.There
may be respiratory difficulty if it causes pressure on the trachea .The
respiration may be noisy.
9. There
may be difficulty in speaking due to infiltration of the recurrent laryngeal
nerve by the cancer.
Investigations
Investigations of Toxic Goitre
|
Test |
Findings |
|
Serum T3 level |
High |
|
Serum T4 level |
High |
|
Serum TSH level |
May be high |
|
Radioactive
iodine uptake by the thyroid gland. |
High |
|
Thyroid scan |
Positive for
active areas. |
|
Serum protein
bound iodine |
High |
Treatment
1.Antithyroid
drugs
.Carbimazole:10 mg 8 hourly, to be
reduced to 5 mg to 15 mg once a day for maintenance.
.Thiouracil:200 mg to 400 mg/day
initially, to be reduced to 50 mg to 100 mg/day for maintenance.
2.Radioactive
iodine: It is taken up by the hyperactive thyroid gland. It is taken up by the
hyperactive tissue. The patient may develop hypothyroidism as a result of this
treatment. This treatment cannot be given to elderly people for fear of
development of carcinoma of the thyroid gland
.
3.Subtotal
thyroidectomy is done, in which, most of the thyroid gland is removed ,expect two
strips on which, the parathyroid glands are attached, along the course of the recurrent laryngeal
nerves.
4.Sedatives
are given for restlessness.
5.Propranolol
is given for restlessness.
Nursing care
1.Complete
bed rest is given.
2.He is
kept in a room which is clean and airy, but without a blast of air coming on
him directly.
3.His
bed should be made every day .it should be clean, dry and warm.
4.His
vital parameters are recorded 4 hourly.
5.Hydrotherapy
is given for fever.
6.Oral
hygiene is maintained every 4 hours.
7.A
bowel movement is ensured every day.
8.Nails
are cut once a week.
9.Sponging
is done every day.
10.Hair
bath is given once a week.
8.Malignant Goitre
Definition
It is a
condition characterised by an
enlargement of the thyroid gland
due to carcinoma.
Aetiology
1.Age:Elderly.
2.Sex:Male
<Female.
3.Radiation
with radioiodine in past.
4.Toxic
goitre.
Clinical features
1.There
is a irregular enlargement of the thyroid gland.
2.The
goitre is on either side of the trachea in the neck.
3.It moves
up and down during swallowing.
4.It is
fixed and cannot be moved easily.
5.It is
hard to feel.
6.Cervical
lymph nodes may be enlarged. They are hard and fixed.
7.There
may be features of thyrotoxicosis, such as the following:-
.Irritability, restlessness.
.Excessive appetite.
.Loss of weight despite adequate food
intake.
.Tachycardia at rest.
.Systolic blood pressure is high.
.There is flushing of face.
.Atrial fibrillation may develop.
.The eyes protrude(exophthalmos).
.Tremors are seen in fingers and
tongue.
.There is intolerance to heat.
.Sweating is excessive.
.Palms are warm and moist.
. Nausea, vomiting and diarrhea may
be present.
8.There
may be respiratory difficulty if it causes pressure on the trachea. the
respiration may be noisy.
9.There
may be difficulty in speaking due infiltration of the recurrent laryngeal nerve
by the cancer.
Investigations
Investigations in Malignant Goitre
|
Test |
Findings |
|
Thyroid scan |
Cold nodule is
seen. |
|
Fine needle
aspiration biopsy |
Malignant cells
are seen. |
|
Cervical lymph
node biopsy |
Thyroid cancer
tissue is seen. |
|
Thyroid function
tests |
As in
thyrotoxicosis. |
Treatment
1.Thyrotoxicosis is controlled by
medical treatment (see before).
2.Radical
thyroidectomy and cervical lymph node dissection is done, or radioiodine therapy
is given.
0 Comments