1. GOITER

2. Anatomy The largest gland of the endocrine system
The isthmus of the thyroid connects the right and left lobes
The gland lies over the trachea down to cricoid cartilage

3. Anatomy Arterial supply :
superior thyroid artery from external carotid artery
inferior thyroid artery from subclavian artery
Venous drainage :
to the internal jugular veins
to the left brachiocephalic vein
Lymphatic drainage:
to the deep cervical nodes

4. Anatomy

5. Physiology of thyroid gland
T3 – triiodothyronine (thyronine)
T4 – tetraiodothyronine (thyroxin)
Thyrocalcitonin ( calcitonin )

6. Physiology of thyroid gland
Functions of thyroid hormones
1. Bone growth
2. CNS maturation
3. Beta-adrenergic effects

7. Physiology of thyroid gland
1. Increase cardiac output
2. Increase basal metabolic rate
3. Increase glycogenolysis, gluconeogenesis, lipolysis

8. Definition
Goiter – the enlargement of the thyroid gland (local or diffuse) based on hyperplasia or degeneration

9. Pathogenesis of diffuse nontoxic goiter
Iodine deficiency results in hypothyroidism
Increasing TSH causes hypertrophy of thyroid

10. Pathogenesis of multinodular goiter
Follicles may become autonomous; certain follicles will have greater intrinsic growth and functional capability

11. Pathogenesis of toxic multinodular goiter
Follicles continue to grow and function despite decreasing TSH

12. Classification Benign Nontoxic Conditions Benign Toxic Conditions
Diffuse and Nodular Goiter
Benign Toxic Conditions
Toxic Multinodular Goiter
Graves’ Disease
Toxic Adenoma

13. Classification
Sporadic goiter
Endemic goiter

14. Classification
Hyperthyroid goiter
Euthyroid goiter
Hypothyroid goiter

15. Clinical features
enlargement
compressive symptoms
thyrotoxicosis

16. Enlargement 0 – the gland is not palpated
I – some part of the gland can be palpated
II- the gland can be seen although the neck is in a normal shape
III – shape of the neck is being changed
IV – configuration of the neck is being changed
V – an giant goiter with complications

17. Treatment
Suppressive Therapy
Antithyroid Medications
I-131
Surgery