Classify Thyroid Swellings: Multinodular Goiter

Multinodular Goiter

Classify thyroid swellings. Describe pathogenesis, clinical features, and management of multinodular goiter.

Answer.

Multinodular Goiter

Multinodular growth is a discordant growth with structurally and functionally altered thyroid follicles which present multiple nodules in thyroid.

“Dealing With Discomfort Caused By Multinodular Goiter”

Multinodular Goiter Pathogenesis

Following is the pathogenesis of multinodular goiter.

“Causes Of Multinodular Goiter In Adults”

Multinodular Goiter Clinical Features

• Multinodular goiter is more common in females. Female to male ratio is 10:1
• It occurs during the age of 20 to 40 years.
• It is a slowly progressive disease.
• There is presence of multiple nodules of various sizes which are present in both lobes and in isthmus which are fim,nodular, non-tender and does not move with deglutition.
• Swelling remain in front of neck, dyspnea is present due to tracheomalacia.
• Dysphagia is also present.
• Hard areas suggest calcifiation and soft areas are suggestive of necrosis.

“The Role Of Ultrasound In Diagnosing Multinodular Goiter”

Multinodular Goiter Management

Management part consists of both investigations and treatment:

Multinodular Goiter Investigations

• T3, T4, TSH and ultrasound neck and FNAC. FNAC should be done from the most dominant and suspected nodule.
  Ultrasound-guided FNAC is more reliable.
  This method identifies impalpable nodules, their number, nature of nodule, and vascularity of nodule.
• X-ray neck: It shows rim of calcification which shows displacement and compression of trachea.
• Indirect laryngoscopy: It shows the mobility of vocal cords.
• Radioisotope iodine scan: It should be done in selected patients only.
• Complete blood picture, routine urine examination, fasting and post prandial blood sugar, serum calcium estimation should be done.

“Comprehensive Overview Of Multinodular Goiter Symptoms”

Multinodular Goiter Treatment

Treatment for multinodular goiter is surgical.

• When complete gland is affcted total thyroidectomy should be done.
• Subtotal thyroidectomy is carried out depending on amount of gland involved and amount of normal gland left along with location of nodules. In this 8 g of thyroid tissue is retained in each lateral lobe.
• Postoperatively L-thyroxine is given to prevent any flctuation in TSH which can lead to recurrent nodule formation.

“Tips To Prevent Complications From Multinodular Goiter”

Multinodular Goiter Prevention

• When patient develops goiter in puberty he/she should be supplemented with 0.1 to 0.2 mg of L thyroxine.
• Patient should be given iodine rich diet.
• Goitrogenic diet, i.e. cabbage and goitrogenic drugs should be avoided.