Here is an approach to Simple Nodular Goitre, in which we are going to discuss its definition, causes, complications, diagnosis (clinical picture [symptoms and signs] and investigations) and management of the disease .
Definition :
Non inflammatory, non neoplastic & non toxic enlargement of thyroid gland (euthyroid)Endemic goitre .Causes
Fluctuation of TSH level à area of active follicle, area of inactive follicle.
Most
nodules are inactive & active follicles are present in internodular
tissues.
Complications of Simple Nodular Goitr
1. Pressure manifestation
3. Carcinoma (0.5 -5%)
4. Hemorrhage
5. Cyst formation & calcification.
6. Secondary thyrotoxicosis
2- Neck swelling
3- Pressure symptoms :
i) Positional Dyspnea & cough à on trachea .
ii) Change in the voice à on Recurrent laryngeal nerve
iii) Dysphagia especially in retrosternal goitre.
iv) Black out ↑ on leaning foreword.
v) Horner’s syndrome à on sympathetic chain
5. Cyst formation & calcification.
6. Secondary thyrotoxicosis
Clinical picture of Simple Nodular Goitre
Age & sex : ♀ 20 & 30 years.Symptoms
1- Pain: uncommon à felt when hemorrhage occurs or late malignancy.2- Neck swelling
3- Pressure symptoms :
i) Positional Dyspnea & cough à on trachea .
ii) Change in the voice à on Recurrent laryngeal nerve
iii) Dysphagia especially in retrosternal goitre.
iv) Black out ↑ on leaning foreword.
v) Horner’s syndrome à on sympathetic chain
Examination
· Asymmetrical thyroid swelling, nodular & firm
· trachea may be displaced.
· May be retrosternal goitre
· Asymmetrical thyroid swelling, nodular & firm
· trachea may be displaced.
· May be retrosternal goitre
Investigations
1.
Total T3 & T4
2.
Free T3 & T4
3.
serum T.S.H
4.
free thyroxin index: Free T4 index = total T4 X free binding sites/100
5.
Thyroid scan
·
tracer dose of iodine is given by mouth à Estimate gland uptake
Treatment :
Sub- total thyroidectomy