GOITER
English) goiter
A goitre (British English) or goiter (American
that does not result
diffuse or nodular enlargement of the thyroid gland
with
process and is not associated
from an inflammatory or neoplastic
abnormal thyroid function. It could
:
be defined as Non-inflammatory,
the thyroid gland
non-neoplastic enlargement of
goiter
Alternative names: Endemic goiter; Colloidal goiter; Nontoxic
a population, and sporadic
Endemic goiter occurs in more than 10% of
do not affect the
goiter is a result of environmental or genetic factors that
general population.
The normal functioning of the thyroid gland enhances metabolism.
the most common cause of [Link]
body needs
Iodine deficiency is
With insufficientiodine in diet, the
iodine to produce thyroid hommone.
iodine to produce the right
thyroidenlargers to trap the available
a sign the thyroid is not
amount of thyroid hormone. So, a goiter can be
The use of iodized salt if
able to make enough thyroid hormone.
in the dict.
prevents a lack of iodine
of the soilalso determines
It ispertinent to note that iodine content
animals. Iodine is washed from the soil
the iodine content of plants and
oceans. In general, areas
by water and is eventually washed out to the
rainfalland flooding are iodine deficient.
with mountain ranges or heavy
on locally grown
Iodine deficiency occurs in populations that depend
or fish protein.
food and rely on vegetable protein rather than on animal
Classification
Simple (non-toxic) goiter.
Toxic goiter.
Simple goiters are more common in:
People over age 40
People with a family history of goiter
o Women
Causes of Simple (non-toxic) goiter.
1. Iodine deficiency.
a. Absolute deficiency: in areas, far from
the sea.
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b: Relative deficiency: due toincreased demand for iodine at pregnancy,
puberty and lactation.
2. Hereditary deficiency of enzymes necessary for thyroxine formation.
3. Goitrogens: Well-known goitrogens as cabbage, cauliflower which
contain thiocy anate which inhibits iodide transport within the thyroid.
Other causes of goiter include:
Autoimmune problem (The body's immune system attacking the thyroid
gland)
Certain medicines (lithium, amiodarone)
Infections
Cigarette smoking
Certain foods (soy, peanuts, vegetables in the broccoli and cabbage
family)
Toxic nodular goiter, an enlarged thyroid gland that has a small, rounded
growth or many growths called nodules, which produce too much
thyroid hormone
Pathophysiology
Iodine deficiency decreased thyroid hormone synthesis and increases
TSH secretion. The increase in TSH causes thyroid glands hyperplasia to
trap moreiodine. The acini are increased in number and lined by tall
columnar cells and çontain little colloid. If iodine deficiency is corrected
after a short time, the acini return to the normal state This is refer to as.
Paren chymatous goiter. However, if iodine deficiency is corrected
after a longer time the acini become distended with colloid and lined by
flat cells this is refer to as Colloid goiter. Repeated cycles of iodine
deficiency & correction willenhance the development of both
Parenchymatous and colloid goiter and areas of fibrosis known as
Nodular goiter
Symptoms
Occasionally, the goiter may produce symptoms caused by pressure on
anterior neck structures,
incesseCoeded
Cleid
une w Qerendhmatus
• Pressure symptoms on the trachea (wheezing, cough, Breathing
dificulties (with very large goiters), especially when lying flat on
the back
Pressure on esophagus (dysphagia), and the recurrent laryngeal
nerve (hoarseness).
Rarely, the obstruction canbe dangerous because of narrowing of the
trachea and the development of tracheitiswith edema and
tracheomalacia, leading to severe narowing of the airway with serious
obstruction resulting in a respiratory emergency. (Tracheal compression
and the results ofits surgical treatment
Investigation
Blood tests may be ordered to measure thyroid function:
Free thyroxine (T4)
Thyroid stimulating hormone (TSH)
To exclude Cancer
Thyroid scan and uptake
Ultrasound of the thyroid
If nodules arefound on an ultrasound, a biopsy may be needed to check
for thyroid cancer.
Treatment
A goiter only needs to be treated if it is causing symptoms.
Treatments for an enlarged thyroid include:
Thyroid hormone replacement pills if the goiter is due to an underactive
thyroid
Small doses of Lugol's iodine or potassium iodine solution if the goiter
is due to a lack of iodine
Surgery (thyroidectomy) to remove all or part of the gland
Prevention
Using iodized table salt prevents most simple goiters.
Nursing Diagnosisfor Goiter
Nursing diagnosis in patients with goitre especially post surgerycan be
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