STRUMA/GOITER Morphology

Uninodular (struma uninodosa): can be either inactive or a toxic nodule Multinodular (struma nodosa): can likewise be inactive or toxic, the latter called toxic multinodular goitre Diffuse (struma diffuse): the whole thyroid appearing to be enlarged.

Function Normal thyroid (nontoxic goiter) Overeactive (toxic goiter) Undereactive (hypothyroid goiter)

Etiology

- Hashimoto or postpartum thyroiditis Excess iodine (Wolff-Chaikoff effect) or lithium ingestion, which decrease release of thyroid hormone

resistance, gonadotropins, and/or thyroid-stimulating immunoglobulins

Riedel thyroiditis

Acute suppurative - Bacterial Chronic - Mycobacteria, fungal, and parasitic

Symptoms and physical signs Hyperthyroidism Symptoms Heat intolerance Hyperdefecation Emotional lability Poor concentration Nervousness Weakness, fatigability Signs Tachycardia Atrial fibrillation Smooth skin; moist, warm palms Tremor Onycholysis Lymphadenopathy Proximal muscle weakness

Hypothyroidism Symptoms Signs Cold intolerance Delayed relaxation of deep tendon reflexes Constipation Lethargy, decreased vigor Dry skin Arthralgia Myxedematous skin changes (generalized) Dry skin Hoarseness Mental clouding, depression

Laboratory studies

Free thyroxine (FT4) Thyroid scan Thyroid stimulating hormone (TSH) Ultrasound of thyroid CT scanning MRI Barium swallow to asses esophageal obstruction

Fine-needle aspiration biopsy

Complications

A tight feeling in your throat Coughing Hoarseness Difficulty swallowing Difficulty breathing

due to suppression by goiter

Surgery is reserved for the following situations:

Severe hyperthyroidism in children Pregnant women who are noncompliant with or intolerant of antithyroid pharmacotherapy Patients with very large goiters or severe ophthalmopathy Patients who refuse radioactive iodine therapy Patients with refractory amiodarone-induced hyperthyroidism Patients who require normalization of thyroid functions quickly, such as pregnant women, women who desire pregnancy in the next 6 months, or patients with unstable cardiac conditions

Therapy Undereactive thyroid Thyroid hormone replacement with levothyroxine (Levothroid, Synthroid) Iodine

Overeactive thyroid Antithyroid drugs (PTU, Methimazole) -blocker Radioactive iodine Thyroidectomy

Postoperative complications Postoperative hemorrhage Injury to the recurrent laryngeal nerves Extravasation of blood into mediastinal space

Stridor Tachycardia and auricular fibrillation Tracheitis

You may need to take levothyroxine after surgery, depending on the amount of thyroid removed.

References emedicine.medscape.com/article/120034 http://www.mayoclinic.com/health/goiter/DS00217 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1655686/?page=4