Gray's Clinical Correlations

Question 1

Case 1: Multinodular Goiter & Hypothyroidism

• Sx: hoarse voice, noisy breathing, increased neck size, slow pulse (45 bpm), irregular knobby mass on anterior aspect of lower neck causing R deviation of trachea
• Causes?

Answer 1

Thyroid: Diminished thyroid hormone, increased TSH = enlarged thyroid; activity/regression periods = nodules (solid/colloid cysts), fibrosis; iodine deficiency or Rx interferes with Thyroxine production causing low BMR (infection) & slow pulse; goiter (painless swelling of gland); thyroid should move when swallowing due (pre-tracheal fascia connecting to larynx)

Hypothyroidism: under active gland

Hoarseness: significant enlargement can compress trachea, “crowding sound” inspiration (stridor), paralysis of vocal cord (left recurrent laryngeal compression),