In partial fulfillment of the requirements for NCM 202 O.R.ward NON-TOXIC NODULAR GOITER (sporadic goiter) Submitted by : Antas, Wilson Bumatay, Jaffrabel Chua, Kayshel Christine Corpuz, Jessielyn Cabalo, Joelyode De Lima, Ginnalyn Estella , Ann-marvie Brief anatomy and physiology of the thyroid gland The thyroid gland is a butterfly-shaped organ and is composed of two conelike lobes or wings. or 'Adam's Apple'). reaching posteriorly the esophagus and carotid sheath. lobus dexter (right lobe) and lobus sinister (left lobe). The organ is situated on the anterior side of the neck. connected via the isthmus. It starts cranially at the oblique line on the thyroid cartilage (just below the laryngeal prominence. . and extends inferiorly to approximately the fifth or sixth tracheal ring It is difficult to demarcate the gland's upper and lower border with vertebral levels because it moves position in relation to these during swallowing. lying against and around the larynx and trachea. Diffuse—enlarging the whole thyroid gland Nodular—enlargement caused by nodules. and sporadic goiter is a result of environmental or genetic factors that do not affect the general population. nodular enlargement of the Thyroid Gland A nontoxic goiter is a diffuse or nodular enlargement of the thyroid gland that does not result from an inflammatory or neoplastic process and is not associated with abnormal thyroid function. simple goiter. Nodular goiter . on the thyroid The development of nodules marks a progression of the goiter.Definition of non-toxic nodular goiter Nontoxic Nodular Goiter or sporadic goiter. Endemic goiter is defined as thyroid enlargement that occurs in more than 10% of a population. It should be evaluated by your doctor. or lumps. uniform follicular epithelial hyperplasia (diffuse goiter) is present. results in multiple nodules (multinodular goiter). with an increase in thyroid mass. nontoxic goiter growth. As the disorder persists.Pathophysiology The histopathology varies with etiology and age of the goiter. the thyroid architecture loses uniformity development of areas of involution and fibrosis interspersed with areas of focal hyperplasia. nodule production and functional autonomy thyrotoxicosis . the incidence of goiter in women is 1.Causes The exact causes of nontoxic goiter are not known. this is a primary cause of goiter in other parts of the world. According to the best estimate. particularly in mountainous areas. a genetic error in proteins that are necessary for thyroid hormone synthesis. Other causes of . propylthiouracil . and millet Iodine deficiency—Iodine deficiency is very rare in the US and other developed countries. phenylbutazone.an autoimmune disease in which the thyroid gland is gradually destroyed by a variety of cell.3 times as great as that in men Age: Sporadic goiter from dyshormonogenesis.and antibody-mediated immune processes Risk Factors Sex: nodular goiter is more common in women than in men. There is often normal thyroid function with a nontoxic goiter.2-4. Endemic goiter due to iodine deficiency occurs during childhood. or aminoglutethimide Regular intake of substances (goitrogens) that inhibit production of thyroid hormone—common goitrogens include foods such as cabbage. goiters may be caused by too much or too little thyroid hormones. brussel sprouts. due to the use of iodized table salt. turnips. Some possible causes of nontoxic goiter include: Heredity (family history of goiters) Regular use of medications such as lithium . with the goiter's size increasing with age. occurs during childhood. or areas that experience heavy rainfall or flooding Hashimoto’s thyroiditis . In general. seaweed. Swelling on the neck Breathing difficulties. especially during childhood Symptoms Nontoxic goiters usually do not have noticeable symptom. thyroid autoantibodies tests may also be done Thyroid scan (scintigraphy)—a picture of your thyroid gland taken after you have been given a shot or drink of a radioisotope to show how your thyroid is functioning and exclude thyroid cancer . An endocrinologist focuses on hormone related issues. A physical exam will be done. or wheezing with large goiter Difficulty swallowing with large goiter Feeling of pressure on the neck Hoarseness Diagnosis Your doctor will ask about your symptoms and medical history. Thyroid nodules increase in incidence with age.sporadic goiter rarely occur before puberty and do not have a peak age of occurrence. Tests may include the following: Examination of the neck—to assess any thyroid enlargement Ultrasound —a test that uses sound waves to identify nodules of the neck and thyroid Blood tests—to assess levels of thyroid hormones (eg. coughing. thyroid stimulating hormone).: Family history of goiter History of radiation therapy to head or neck. Your doctor may recommend a specialist. In this case they do not need treatment. Talk with your doctor about the best plan for you. Interventions . Treatment may be needed if the goiter grows rapidly. affects neck or obstructs breathing . TSH is the thyroid-stimulating hormone that causes growth. and the nodule is found to be cancerous. Prevention Be sure that diet contains enough iodine. you will need treatment. It is less effective for goiters that have progressed to the nodular stage. This therapy is most effective for early stage goiters that have grown due to impaired hormone production. If a nontoxic goiter progresses to the nodular stage. Treatment options include the following: Hormone Suppression Therapy Thyroid hormone medication is used to suppress secretion of thyrotropin (TSH). It is the treatment of choice if the goiter is so large to cause difficulty in breathing or swallowing. 50%-60% are noncancerous Barium swallow —a test to determine if the enlarged goiter is compressing the esophagus. thus causing swallowing difficulty X-ray of neck and chest for large goiters—to see if the trachea is compressed Treatment Nontoxic goiters usually grow very slowly. Thyroidectomy A surgery to remove a portion or all of the thyroid gland. They may not cause any symptoms. It is used in the elderly when surgical treatment is not an option. Radioactive Iodine Radioactive iodine treatment is used to reduce the size of large goiter.Fine needle aspiration biopsy —a tissue sample is taken with a small needle to determine if it is benign or malignant (cancer). allowing them to monitor their own body for early changes in gland size Advise patient to always include iodine in meals. patient cyanosis as it may indicate tracheal obstruction/laryngeal spasm Place patient on a semifowler position and place pillow at the back of the neck to prevent hyperextension of the neck. Instruct patient not to bend the neck as it reduces the likelihood of tension in the incision site. Measure the patient's neck circumference to check for progressive thyroid gland enlargement. Thyroid self-examination may be taught to patients. emphasize the importance of iodized salt and medications Provide preoperative teaching and postoperative care if subtotal thyroidectomy is indicated. Check for hard nodules in the gland. which may indicate cancer. . ronchi . Explain patient the temporary impairment of verbal capability. Preoperatively Provide information about the surgical procedure and relieve patient anxiety. Investigate reports of difficulty swallowing or drooling of oral secretions as it may indicate edema/sequestered bleeding in tissues surrounding the operative site. Postoperatively Relieve pain Prevent infection Asses for stridor . com/article/120392-overview#showall http://en.med.aspx?chunkiid=96739 http://library.html .edu/WebPath/ENDOHTML/ENDO021.medscape.utah.org/wiki/Goiter http://www.com/healthatoz/pages/HealthLibrary.Bibliography http://emedicine.upmc.wikipedia.