Enlarged thyroid gland

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Enlarged thyroid gland

• Dr. M. Malek

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Enlarged thyroid

• Diffusely enlarged (goiter)
• Multinodular (Multinodular goiter)
• Partially enlarged (single thyroid nodule)

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• Goiter refers to an enlarged thyroid gland
• Biosynthetic defects
• Iodine deficiency
• Autoimmune disease
• Nodular diseases
• By different mechanisms

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• Biosynthesis effect iodine deficiency?
• Reduced efficiency of thyroid hormone
  synthesis
• ?Increase TSH
• ?Stimulation of thyroid growth
• (compensatory mechanism)

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• Enlargement of the thyroid suggests nothing about
  the function of thyroid.
• Because can be
• Hyper functioning
• Normal functioning
• Hypo functioning

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Evaluation

• Is undertaken principally to determine the
  thyroid function
• presence or absence of malignancy.

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Thyroiditis

• Fever, enlarged tender thyroid
• Bacterial infection
• TFTs are usually normal.

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Grave, s (diffuse toxic goiter)

• Is the most common cause of goiter
  hyperthyroidism.
• An autoimmune disease
• Antibodies act to simulate thyroid function.
• Exophthalmos, burning, itching, pretibial
  dermopathy.

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Trophoblastic tumors

• Rarely can simulate goiter hyperthyroidism.
• HCG has some biologic cross-activity with TSH.

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Jadbasedow phenomenon

• Hyperthyroidism induced by iodine
  supplementation.

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De quervain,s thyroiditis

• Subacute granulomatous thyroiditis
• Painful enlargement
• Fever, malaise, chills
• F/M 3
• Unknown cause but usually follows a viral
  infection by several weeks

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Subacute lymphocytic thyroiditis

• A painless thyroiditis, hyperthyroidism
  enlargement
• Unknown cause probably autoimmune

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Hashimoto

• Chronic lymohocytic thyroiditis
• Most common thyroid disorders in USA
• Painless palpable goiter
• Usually initially euthyroid
• But ultimately almost always hypothyroid
• Hyperthyroidism must be distinguished from Graves

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Hashimoto

• Dx Antimicrosomal Abs In approximately 95
• Antithyroglobolin Abs in 50 to 60
• Radioactive iodine uptake may be normal, low or
  increased

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Reidel ,s thyroiditis

• A rare disorders
• A firm, enlarged gland
• Sclerosing fibrous infiltration
• Hypothyroidism

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Endemic goiter

• In a large fraction of the population.
• Most commonly a result of iodine deficiency.
• Now is very rare in the USA owing to iodinization
  of salt.

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Sporadic goiter

• An enzymatic defect.
• Leading to low thyroid hormone levels.
• Elevated level of TSH.

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Pituarity adenoma

• May secret TSH autonomously.
• Without sensitivity to negative feedback.

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TFT

• Thyroid function tests should be performed in all
  patients with goiter to exclude thyrotoxicosis or
  hypothyroidism.

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Thyroid scanning

• Thyroid scanning is not generally necessary but
  will reveal increased uptake in iodine deficiency
  and most cases of dyshormonogenesis.

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Ultrasound

• Ultrasound is not generally indicated in the
  evaluation of diffuse goiter unless
• a nodule is palpable on physical examination.