Goiter diffuse

Ultrasonography Solitary nodule Multiple nodules Goiter Diffuse hypoechogenic Diffuse hypoechogenic... 

Hyperthyroidism (thyrotoxicosis), defined as excessive thyroid activity, causes a state of thyroid hormone excess (thyrotoxicosis) characterized by an increased metabolic rate, increase in body temperature, sweating, tachycardia, tremor, nervousness, increased appetite and loss of weight. Common causes of hyperthyroidism are toxic multinodular goiter, toxic adenoma or diffuse toxic goitre ( Graves disease). Antithyroid diugs (methimazol, carbimazole, propylthiouracil) block thyroid hormone production and are hence suitable for the treatment of hyperthyroidism. 

Autoimmune polyglandular syndrome-Chron c autoimmune thyroiditis may occur in association with other autoimmune disorders. Treat patients with concomitant adrenal insufficiency with replacement glucocorticoids prior to initiation of treatment. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens. Nontoxic diffuse goiter or nodular thyroid disease Use caution when administering levothyroxine to patients with nontoxic diffuse goiter or nodular thyroid disease in order to prevent precipitation of thyrotoxicosis. If the serum TSH is already suppressed, do not administer levothyroxine. 

The most common form of hyperthyroidism is Graves disease, or diffuse toxic goiter. The presenting signs and symptoms of Graves disease are set forth in Table 38-4. 

Extensive iodine absorption from povidone-iodine can cause transient hypothyroidism or in patients with latent hypothyroidism the risk of destabilization and thyrotoxic crisis (SEDA-20, 226 SEDA-22, 263). Especially at risk are patients with an autonomous adenoma, localized diffuse autonomy of the thyroid gland, nodular goiter, latent hyperthyroidism of autoimmune origin, or endemic iodine deficiency (51). 

A 67-year-old man took amiodarone 200 mg/day for 20 months, after which it was withdrawn 8 months later his serum TSH was suppressed and the free thyroxine and free triiodothyronine were both raised there were no thyroid antibodies and an ultrasound scan showed a diffuse goiter with a nodule in the right lobe and reduced iodine uptake (45). Histological examination of the nodule showed a papillary cancer. 

Thyroid function tests were measured before and after treatment of amiodarone-induced hyperthyroidism (n = 12) and the response to combined antithyroid and glucocorticoid treatment (n = 11) was recorded (61). One patient had type 1 hyperthyroidism, nine had type 2, and two probably had a mixed form. Six patients had diffuse hypoechoic goiters. The median time to euthyroidism (defined as a normal free T3 concentration) with a thionamide + prednisolone (starting dose 20-75 mg/day) was... 

There are two basic categories of thyroid-related orbitopathy infiltrative and noninfiltrative. Approximately 90% of patients have noninfiltrative disease. Noninfiltrative (class 1) thyroid-related eye disease is characterized by the mildest form of ocular involvement, with eyelid retraction but minimal proptosis. This occurs in up to 50% of patients with toxic diffuse goiter and can begin at any age, but patients tend to be yoimger, and female persons outnumber male persons in a ratio of up to 6 1. 

Hyperthyroidism results in a hypermetabolic state due to an excess of thyroid hormones. Hyperthyroidism is more common in women (2%) than men (0.1%). Graves disease is an autoimmune disorder that leads to hyperthyroidism, diffuse goiter, ophthalmopathy, dermopathy, and acropachy. Graves disease is the most common cause of hyperthyroidism, more common than multi- or uninodular goiters. 

TSH-suppressive levothyroxine therapy may also be given to patients with nodular thyroid disease and diffuse goiter, to patients with a history of thyroid irradiation, and to patients with thyroid cancer. The rationale for suppression therapy is to reduce TSH secretion, which promotes growth and function in abnormal thyroid tissue. In... 

A small number of patients treated with Li develop diffuse thyroid enlargement patients usually remain euthyroid, and overt hypothyroidism is rare. In patients who do develop goiter, discontinuation of Li or treatment with thyroid hormone results in shrinkage of the gland. 

Disorders of Thyroid Growth Disorders of thyroid growth include diffuse enlargement of the thyroid gland, or goiter, nodular thyroid disease, and thyroid cancer. Goiter may be associated with hypothyroidism and the resultant TSH-induced hypertrophy and hyperplasia of thyroid cells. 

Iodide concentrations higher than normal inhibit iodination of tyrosine, an effect that is useful in the treatment of thyroid disease. Inadequate iodine intake results in diffuse enlargement of the thyroid (goiter). 

Graves disease is suggested by the presence of bruit in a diffusely enlarged, firm goiter. Tracheal deviation is frequently visible or palpable if the goiter is asymmetric. Rarely, dilated neck veins can be seen when there is an obstruction on the neck veins by the enlarged thyroid gland. 

Treatment of goiter is dependent on the type of goiter, i.e., diffuse vs. nodular goiter. 

Graves disease, uncommon in the elderly, usually presents with a diffusely enlarged goiter with a bruit. The common symptoms of heat intolerance, tremor, tachycardia, and so on, may be erroneously attributed to normal aging or commonly present coexisting diseases in the elderly. 

---