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GOITER
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GOITER

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  1. GOITER

  2. 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

  3. 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

  4. Anatomy

  5. Physiology of thyroid gland T3 – triiodothyronine (thyronine) T4 – tetraiodothyronine (thyroxin) Thyrocalcitonin ( calcitonin )

  6. Physiology of thyroid gland Functions of thyroid hormones 1. Bone growth 2. CNS maturation 3. Beta-adrenergic effects

  7. Physiology of thyroid gland 1. Increase cardiac output 2. Increase basal metabolic rate 3. Increase glycogenolysis, gluconeogenesis, lipolysis

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

  9. Pathogenesis of diffuse nontoxic goiter • Iodine deficiency results in hypothyroidism • Increasing TSH causes hypertrophy of thyroid

  10. Pathogenesis of multinodular goiter • Follicles may become autonomous; certain follicles will have greater intrinsic growth and functional capability

  11. Pathogenesis of toxic multinodular goiter • Follicles continue to grow and function despite decreasing TSH

  12. Classification • Benign Nontoxic Conditions • Diffuse and Nodular Goiter • Benign Toxic Conditions • Toxic Multinodular Goiter • Graves’ Disease • Toxic Adenoma

  13. Classification • Sporadic goiter • Endemic goiter

  14. Classification • Hyperthyroid goiter • Euthyroid goiter • Hypothyroid goiter

  15. Clinical features enlargement compressive symptoms thyrotoxicosis

  16. 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

  17. Treatment • Suppressive Therapy • Antithyroid Medications • I-131 • Surgery