Goiter
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GOITER. Anatomy. The largest gland of the endocrine system The isthmus of the thyroid connects the right and left lobes The gland lies over the trachea down to cricoid cartilage. Anatomy. Arterial supply : superior thyroid artery from external carotid artery

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GOITER

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Goiter

GOITER


Anatomy

Anatomy

  • The largest gland of the endocrine system

  • The isthmus of the thyroid connects the right and left lobes

  • The gland lies over the trachea down to cricoid cartilage


Anatomy1

Anatomy

Arterial supply :

superior thyroid artery from external carotid artery

inferior thyroid artery from subclavian artery

Venous drainage :

to the internal jugular veins

to the left brachiocephalic vein

Lymphatic drainage:

to the deep cervical nodes


Anatomy2

Anatomy


Physiology of thyroid gland

Physiology of thyroid gland

T3 – triiodothyronine (thyronine)

T4 – tetraiodothyronine (thyroxin)

Thyrocalcitonin ( calcitonin )


Physiology of thyroid gland1

Physiology of thyroid gland

Functions of thyroid hormones

1. Bone growth

2. CNS maturation

3. Beta-adrenergic effects


Physiology of thyroid gland2

Physiology of thyroid gland

1. Increase cardiac output

2. Increase basal metabolic rate

3. Increase glycogenolysis, gluconeogenesis, lipolysis


Definition

Definition

Goiter – the enlargement of the thyroid gland (local or diffuse) based on hyperplasia or degeneration


Pathogenesis of diffuse nontoxic goiter

Pathogenesis of diffuse nontoxic goiter

  • Iodine deficiency results in hypothyroidism

  • Increasing TSH causes hypertrophy of thyroid


Pathogenesis of multinodular goiter

Pathogenesis of multinodular goiter

  • Follicles may become autonomous; certain follicles will have greater intrinsic growth and functional capability


Pathogenesis of toxic multinodular goiter

Pathogenesis of toxic multinodular goiter

  • Follicles continue to grow and function despite decreasing TSH


Classification

Classification

  • Benign Nontoxic Conditions

    • Diffuse and Nodular Goiter

  • Benign Toxic Conditions

    • Toxic Multinodular Goiter

    • Graves’ Disease

    • Toxic Adenoma


Classification1

Classification

  • Sporadic goiter

  • Endemic goiter


Classification2

Classification

  • Hyperthyroid goiter

  • Euthyroid goiter

  • Hypothyroid goiter


Clinical features

Clinical features

enlargement

compressive symptoms

thyrotoxicosis


Enlargement

Enlargement

  • 0 – the gland is not palpated

  • I – some part of the gland can be palpated

  • II- the gland can be seen although the neck is in a normal shape

  • III – shape of the neck is being changed

  • IV – configuration of the neck is being changed

  • V – an giant goiter with complications


Treatment

Treatment

  • Suppressive Therapy

  • Antithyroid Medications

  • I-131

  • Surgery


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