Adult Medical-Surgical Adult Medical-Surgical Nursing Nursing

Endocrine Module: Endocrine Module:

GoitreGoitre

GoitreGoitre

A goitre is an enlargement of the A goitre is an enlargement of the thyroid glandthyroid gland

Goitre: Classification and AetiologyGoitre: Classification and Aetiology

ToxicToxic goitre (hypersecretion): Grave’s goitre (hypersecretion): Grave’s disease, hyperthyroidism (auto-immune: disease, hyperthyroidism (auto-immune: thyroid-stimulating antibodies like TSH → thyroid-stimulating antibodies like TSH → hyperplasia and ↑ secretion)hyperplasia and ↑ secretion)

Non-toxicNon-toxic (hyposecretion): (hyposecretion): Hashimotos disease: hypertrophy related Hashimotos disease: hypertrophy related

to growth-stimulating antibodies but to growth-stimulating antibodies but hyposecretion (auto-immune thyroiditis)hyposecretion (auto-immune thyroiditis)

Increased TSH in response to Increased TSH in response to hyposecretion of thyroid → enlarged glandhyposecretion of thyroid → enlarged gland

Iodine deficiency (compensatory growth)Iodine deficiency (compensatory growth)

Goitre: DiagnosisGoitre: Diagnosis

Hormonal assays: TSH, T3, T4, FT4Hormonal assays: TSH, T3, T4, FT4

Measure presence of thyroid antibodiesMeasure presence of thyroid antibodies

Scan to measure uptake of radioactive Scan to measure uptake of radioactive iodine: Iiodine: I131131

Needle biopsy to rule out malignancy and Needle biopsy to rule out malignancy and auto-immune destruction of tissue auto-immune destruction of tissue

Goitre: ManagementGoitre: Management

If related to hyposecretion, treat with If related to hyposecretion, treat with thyroxine to prevent further enlargementthyroxine to prevent further enlargement

If related to iodine deficiency, treat causeIf related to iodine deficiency, treat cause If related to hyperthyroidism, treat the If related to hyperthyroidism, treat the

condition (anti-thyroid drugs, radiation condition (anti-thyroid drugs, radiation therapy or surgery)therapy or surgery)

If increased pressure symptoms, surgery If increased pressure symptoms, surgery may be necessarymay be necessary