PATHOPHYSIOLOGY PRECIPITATING FACTOR

PREDISPOSING FACTOR Lack of dietary iodine

Sex : Female Pregnancy
Age : Increasing
Deficient Iodine Menopause
Medication
Over stimulation of the thyroid Radiation
Hypothalamus

Enlargement of the thyroid Increase secretion of TRH

Pituitary gland

Pressure in trachea Visible anterior neck mass

Excess pituitary secretion of TSH
Pai
Increase pressure in nearby nerve
Difficulty in breathing
root endings Stimulates thyroid gland
Pai Increase proliferation of
Pain catecholamine receptor
Secretion of T3 and T4

Difficulty swallowing
Sympathomimetic effect
Increase sympathetic activity

Thyrotoxicosis

Hyper metabolic state Increase peripheral vasodilation Increasing heart contractility

Increase metabolism Increase blood supply Increase heart rate

Increase BMR Tachycardia and

Increase blood volume
palpitation
Overstimulation of the gut Increase Glucose degradation
Cardiac arrhythmia

\
Hypermotility Weakness Increase O2 demand Increase heat production

Diarrhea Tachypnea Heat intolerance Skin is warm and flushed

j

Malabsorption Excessive sweating

Loss of water and electrolytes Skin is moist and soft

Dehydration Imbalance electrolytes

INTERPRETATION:

Goiter is a disease in the thyroid gland. It is the enlargement of the thyroid gland. According to the studies, the cause of the thyroid
disorders is not yet known but there are factors being considered why goiter exists. Examples would be if the patient has a family history or pre-
existing hyperthyroidism, or having Graves Disease. Graves Disease is also one form of hyperthyroidism and an autoimmune disease
characterize by goiter and protrusion of eye balls. Iodine deficiency is also considered in the development of the goiter. Other environmental
factors that could lead to the formation of goiter is called Endemic Goiter.

Non Toxic Goiter or simply Goiter starts when there is a deficient in iodine to produce enough thyroid hormone necessary to the
normal functionality of the body due to its precipitating or predisposing factors, normally, the hypothalamus secrete Thyroid Releasing Hormone
(TRH) to stimulate the pituitary gland to secrete T3 and T4. However, when there is an abnormal or increase secretion of TRH from the
hypothalamus, it will stimulate the pituitary gland to release excessive amount of Thyroid Stimulating Hormone (TSH) which will signals the
thyroid gland to secret excessive volume of T3 (Tri-iodothyronine) and T4 (Thyroxine) into the body. Because of this, it will stimulate the
sympathetic nervous system of the body resulting to increase sympathetic activity. Increase sympathetic activity means increase body activity or
over stimulation of body to increase cellular activity that will result to hyper metabolic state that could result to increase BMR which will lead to
increase glucose degradation in the body therefore increase in O2 demand because any cellular activity needs oxygen to function which leads to
tachypnea or hyper respiration to meet the oxygen needs. Increase glucose degradation as well as increase in peripheral vasodilation resulting to
increase heat production making the patient or the person sensitive to heat. As the body tends to cool down and maintain homeostasis, sweating
may occur. Because of this, the skin feels warm, soft, and moist as well as looks flushed. Increase in BMR could overstimulate the gut that will
induce hyper motility of the bowel which can lead to diarrhea and eventually malabsorption of the nutrition and vitamins taken that can lead to
weakness as well as loss of water and electrolytes from the system. With continues loss of fluid and electrolytes, the patient will be dehydrated
and will have irregular electrolytes loss which result to dysrhythmia, tremor or stiffness of the muscle. Weakness could also result to excessive
degradation of glucose in the body to provide the cells nutrients and energy needed. Increase in sympathetic activity means increase cardiac
contractility and vasodilation of the periphery due to secretion of catecholamine such as epinephrine and norepinephrine. With the increase in
blood supply to the heart due to peripheral vasodilation and to increase heart rate because of increase cardiac contraction, this will now result to
increase cardiac output which can lead to tachycardia and palpitation and eventually cardiac arrhythmia. Toxic diffuse goiter happens when there
are small rounded masses developed which secretes additional thyroid hormone in the body, therefore, resulting to increase T3 and T4 but low
TSH level. These small rounded masses developed due to overstimulation of the thyroid gland resulting to hypertrophy of the thyroid, therefore
non toxic goiter could also lead toxic diffuse goiter once overstimulated.