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The thyroid disease GOITRE, Study notes of Clinical Medicine

It has clinical knowledge of thyroid gland . It includes disease of thyroid gland known as Goitre. It includes clinical features and investigations of Goitre disease

Typology: Study notes

2018/2019

Uploaded on 03/26/2023

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CLINICAL FEATURES AND
INVESTIGATIONS OF GOITER
-BY PRASHIL D. CHHATRALIYA ( 4TH BHMS )
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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

  1. 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

  1. TPO Antibodies :-
  • Useful to identify Patient at increase risk of Autoimmune Thyroid Disease.
  1. Urine Iodine Level :-
  • If low ( <50 micrograms/ Liter ) , suggest Iodine Deficiency.
  1. Thyroid Scanning :-
  • Generally not necessary , but it reveal Increased uptake in Iodine Deficiency or Dyshormogenesis.
  1. 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

  1. 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 :-

  1. Barium Swallow :-
  • It reveal extent of Esophageal Compression.
  1. USG :-
  • To identify which nodule is biopsied in the basis of USG.
  1. 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

  1. Investigation :-
  1. USG :-
  • To assess the pressure of discrete nodule corresponding to areas of decrease uptake.
  • If Nodule presents the ……
  1. FNA :-
  • Based on Sonographic frame and size FNA done.
  1. 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.