Goitre

Question 1

What is a diffuse goiter?

Answer 1

A goiter that has spread throughout all of the thyroid

Question 2

What are the differences between a simple and multinodular goiter?

Answer 2

Simple: has no clear cause, smooth and soft
Multinodular: formed by fibrosis separating areas of enlargement. Common in older pts, most common cause of tracheal and oesophageal compression, laryngeal nerve palsy. Usually irregular.

Question 3

What is a toxic goiter?

Answer 3

A goiter with hyperthyroidism. Most commonly d/t Graves’ disease. Can be caused by inflammation or multinodular goiter.

Question 4

What is a non toxic goiter?

Answer 4

Goiter caused by drugs e.g. Lithium or other autoimmune disorders

Question 5

What are the differences between sporadic(non-toxic) and endemic goiter?

Answer 5

Sporadic: occurs irregularly, no pattern. Aetiology involves a lack of T3 and T4 causing a rise in TSH and thyroid hyperplasia. This can be brought about by: iodine deficiency, inherited enzyme defects in TH production or drugs inducing hyperthyroidism.

Endemic: formerly common in mountainous regions which lacked iodine -> iodine deficiency -> abnormalities in TH production causing a rise in TSH and thyroid hyperplasia. Treated with iodination of food via iodinated table salt.

Question 6

Aetiology and Pathogenesis of multinodular goiter

Answer 6

Pathogenesis is not well understood.
Nodules grow and autonomously produce excess TH.
F=M frequency, generally >40y/o.
Nodules are generally benign adenomas and don’t increase the risk of thyroid cancer.

Question 7

What are the complications of a multinodular goiter?

Answer 7

Difficulty swallowing or breathing
Hyperthyroidism
CVS: Atrial fibrillation,tachycardia, CHF
No ophthalmology or dermopathy (these only occur in Graves’)

Question 8

Define the term “goitre”

Answer 8

Enlargement of the whole thyroid, without hyperthyroidism.