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Simple Nodular Goitre causes, diagnosis, complications and treatment

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
2. Infection very rare
3. Carcinoma (0.5 -5%)
4. Hemorrhage
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

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
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Tamer Mobarak

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