2. Goiter (symptoms, diagnosis, treatment)

Question 1

Symptoms

Answer 1

Based on the nature of the goiter, it’s either:

• hyperthyroidism symptoms
  or
• hypothyroidism symptoms

Question 2

How does non-toxic goiter develop

Answer 2

Disapropriate TSH:T3/T4 ratio causes overstimulation and hypertrophy of thyroid gland, and eventually will form nodules.

The hypertrophy will actually make up for the lack of T3/T4 production until the TSH levels gets too high.

Question 3

Progression from non-toxic to toxic goiter

Answer 3

TSH receptor mutation -> TSH receptors are “always on” and will independently use iodine to produce thyroid hormone regardless of circulating TSH/thyroid hormones

Question 4

Thyroid mass diagnosis and general treatment

massive card, using as a note

Answer 4

1. History and physical exam
2. US to determine the nature of the mass (diffuse, single nodule, multinodular)
   a. if solid nodule -> FNAB
   - if benign -> regular follow ups
   - if growing -> levothyroxine and follow up
   - if malignant -> LT + surgery

b. if diffuse goiter (without compression)
- iodine supplement and follow ups
- treatment of either hypo- or hyperthyroidism

3. (this step happens together with US) - always check TSH, T3 and T4 to help guide and confirm the diagnosis
   a. TSH low -> scintigraphy
   - cold nodule -> monitor
   - hot nodule -> toxic goiter

Question 5

Treatment of Grave’s

Answer 5

• Radioiodine
• Antithyroid drugs
• Subtotal thyroidectomy

Question 6

Subtotal thyroidectomy indications

Answer 6

• Relapse after drug treatment
• Intolerance of antithyroid drugs
• Contraindication of radioiodine therapy
• Larger goiter
• Patient preference

Question 7

Types of thyroid surgeries

Answer 7

• Enucleation
• Partial lobectomy
• Subtotal lobectomy
• Thyroidectomy (near)total
• Block dissection
• Palliative operations

Question 8

Early complications of thyroid operations

Answer 8

• Recurrent laryngeal nerve palsy
• Superior laryngeal nerve palsy
• Hemorrhage
• Pneumothorax
• Damage to thoracic duct
• Damage to carotid artery
• Damage to jugular vein
• Thyroid crisis
• Hypoparathyreosis
• Infection

Question 9

Late complications of thyroid operations

Answer 9

• Cheloid scar
• Recurrence of hyperthyroidism
• Recurrent goiter