ENDOCRINE DISORDERS PRESENTATIONS ON HAP

Nursing note on surgery and surgical nursing

1. ENDOCRINE SYSTEM endocrine system consists of the tissues (mainly glands) that create and release  hormones .ENDO (INSIDE) CRINE (TO SECRETE) Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to your organs, skin, muscles and other tissues . These signals tell your body what to do and when to do it. Hormones are essential for life and your health

2. GLAND Glands are specialized cells or groups of cells (tissues) that release important chemicals. Some glands release chemicals for the surrounding area only. Other glands release chemicals that travel throughout your body. All glands consist of epithelial tissue, one of the four main tissues found in your body. Glands are special because of how they make and release various chemicals. There are two main types of glands:

3. CONT Exocrine glands These glands have tubelike ducts that transport whatever they make. Some examples of things that exocrine glands make include: Breast milk Enzymes that help with digestion Mucus Saliva Sweat Tears

4. CONT Endocrine glands These glands secrete what they make into your bloodstream without the use of ducts. The chemicals and substances they make can be useful throughout your body. Examples include: Complex blood proteins like clotting factors Metabolic hormones like  ghrelin , glucagon and insulin Neurotransmitters like adrenaline and  norepinephrine Sex hormones like estrogen and testosterone

5. FUNCTIONS OF THE ENDOCRINE SYSTEM The main function of your endocrine system is to release hormones into your blood while continuously monitoring the levels. Hormones deliver their messages by locking into the cells they target so they can relay the message. You have more than 50 different hormones, and they affect nearly all aspects of your health — directly or indirectly. Some examples include:

6. CONT Metabolism. Homeostasis (constant internal balance), such as blood pressure and blood sugar regulation, fluid (water) and electrolyte balance and body temperature. Growth and development. Sexual function. Reproduction. Sleep-wake cycle.

7. CONT Very small amounts of hormones can trigger significant responses and changes in your body. If your body has too little or too much of a hormone, it affects your health. This often causes noticeable symptoms

8. ANATOMY Your endocrine system consists of three types of tissues: Endocrine glands. Organs. Endocrine-related tissues

9. Endocrine system glands Glands are special tissues in your body that create and release substances. Endocrine glands make and release hormones directly into your bloodstream. The endocrine glands in your body from head to toe include : Pineal gland : This is a tiny gland in your  brain that’s beneath the back part of your corpus callosum . It makes and releases the hormone  melatonin . Pituitary gland : This is a small, pea-sized gland at the base of your brain below your hypothalamus. It releases eight hormones, some of which trigger other endocrine glands to release hormones.

10. CONT Thyroid gland : This is a small, butterfly-shaped gland at the front of your neck under your skin. It releases hormones that help control your metabolism. Parathyroid glands : These are four pea-sized glands that are typically behind your thyroid. Sometimes they exist along your esophagus or in your chest (ectopic parathyroid glands). They release parathyroid hormone (PTH), which controls the level of calcium in your blood.

11. CONT Adrenal glands : These are small, triangle-shaped glands on top of each of your two kidneys. They release several hormones that manage bodily processes, like metabolism, blood pressure and your stress response. You have other glands in your body that aren’t endocrine glands, such as sweat glands (a type of exocrine gland).

12. Endocrine system organs Certain organs in your body also make and release hormones. An organ is a group of tissues that form a structure that performs specific important functions in your body. The organs that are part of your endocrine system include : Pancreas : This organ is in the back of your abdomen (belly). It’s both an organ and a gland and is also part of your digestive system. It releases two hormones that are essential to maintaining healthy blood sugar levels: insulin and glucagon.

13. CONT Hypothalamus : This is a structure deep within your brain (which is an organ). It’s the main link between your endocrine system and your nervous system. It makes two hormones that your pituitary gland stores and releases ( oxytocin and vasopressin) and makes and releases two hormones (dopamine and  somatostatin ). Ovaries : These are small, oval-shaped glands located on either side of your uterus. They produce and store your eggs (also called ova) and make sex hormones that control your menstrual cycle and  pregnancy.

14. CONT Testicles ( teste ); These are small, round organs underneath your  penis in your scrotum. They make sperm and sex hormones, particularly testosterone . Adipose tissue (body fat) : This is a connective tissue that extends throughout your body. It’s found under your skin (subcutaneous fat), between your internal organs (visceral fat) and in the inner cavities of bones (bone marrow adipose tissue). Adipose tissue releases many different hormones, including  leptin ,  angiotensin  and  adiponectin .

15. Other tissues that release hormones Other tissues in your body release hormones. But we don’t typically think of them as endocrine system tissues because they have other, more significant functions or roles. They include: Digestive tract (stomach and small intestine) : Your digestive tract is the largest endocrine-related organ system. It makes and releases several hormones that play a role in your metabolism. Examples include gastrin and  ghrelin .

16. CONT Kidneys : Your kidneys are two bean-shaped organs that filter your blood. They’re part of your urinary system, but they also produce hormones, like erythropoietin and  renin . Liver : Your liver is part of your digestive system, but it also produces hormones, including insulin-like growth factor 1 (IGF-1) and angiotensinogen . Heart : When your blood pressure rises, your heart releases two hormones called A-type natriuretic peptide and B-type natriuretic peptide

17. CONT Placenta : The placenta is a temporary endocrine organ that forms during pregnancy. It produces hormones that are important for maintaining a healthy pregnancy and preparing your body for  labor and  breastfeeding.

18. What are endocrine system diseases? There are hundreds of conditions related to issues with your endocrine system. Hormonal imbalances make up a significant number of endocrine diseases. This typically means there’s too much or not enough of one or more hormones. But issues directly affecting endocrine system glands and organs, like benign and cancerous tumors, also account for endocrine diseases.

19. ENDOCRINE DISORDERS Endocrine disorders  occur when the endocrine system produces too many or too few hormones, or when the body doesn't respond to hormones correctly

20. CONT The below groupings cover some — but certainly not all — endocrine system-related conditions. Diabetes and metabolic conditions: Type 1 diabetes. Type 2 diabetes. Gestational diabetes Metabolic syndrome. Obesity

21. CONT Endocrine cancers and tumors: Adrenal tumors. Neuroendocrine tumors. Pancreatic cancer. Parathyroid cancer. Parathyroid tumors Pituitary tumors. Thyroid cancer.

22. CONT Thyroid disease ; Hypothyroidism and hyperthyroidism. Thyroiditis . Thyroid nodule.

23. CONT Sexual development, function and reproduction conditions: Amenorrhea (absent periods). Erectile dysfunction. Growth hormone deficiency and excess ( acromegaly or  gigantism). Hormonal acne. Hormone-related infertility.

24. CONT Hypogonadism . Menopausal disorders. Polycystic ovary syndrome ( PCO). Premenstrual syndrome (PMS ). Calcium and bone conditions : Hypercalcemia  and  hypocalcemia . Osteopenia  and osteoporosis. Vitamin D deficiency.

25. COMMON TYPES OF ENDOCRINE DISORDERS Adrenal insufficiency (Addison’s Diseases);the body’s adrenal glands produce too little cortisol and aldosterone Diabetes ;A chronic condition when the pancreas fails to produce adequate insulin to regulate blood glucose level. Grave’s Disease;(Hyperthyroidism) an immune system disorder that affects the production of thyroid hormmones Hashimoto’s Disease(Hypothyroidism) ;A condition that causes the undereactive thyroid gland

26. cont Gigantism ( Acromegaly ); The condition where there is over production of growth hormone by the pituitary gland increases the bones’ size. Cushing’s disease; Overuses of steriods causes a benign pituitary gland tumor leading to ACTH imbalance ,which stimulates the adrenal glands to produce more cortisol . Polycystic Ovarian Syndrome (PCOS) ;This disorder affects women with high level of androgens and small cysts on their ovaries.it can cause irregular or missed periods, hair growth and infertility.

27. CAUSES OF ENDOCRINE DISORDERS A genetic disorder  Infection or disease  Injury to an endocrine gland Feedback system failure Dysfunction of the endocrine gland Inactivation of the hormones by antibodies at the target cells.

28. Diagnostic investigations for ED Blood tests:  These are the most common diagnostic tool, measuring the concentration of specific hormones like thyroid hormones, cortisol , and prolactin . They can also measure blood glucose levels, with tests like Hemoglobin A1c providing a long-term average of blood sugar control.  Urine tests:  These can evaluate hormone excretion over a 24-hour period, which provides a broader picture of daily hormone fluctuations.  Saliva tests:  While less common, some tests may use saliva to measure hormone levels. 

29. cont Pancreatic endocrine tumor testing Endocrinology offers special tests to look for cancers in the hormone-producing cells of the pancreas. These include: Positron emission tomography (PET) scans . These involve injecting safe radioactive tracers that cancer cells take up in higher amounts than normal cells. This makes them more visible in a CT scan or MRI. Laparoscopic biopsies. For these, a surgeon sends a fine needle and camera through a tube to the pancreas. They then sample any tissue that looks abnormal.

30. cont Blood tests Blood tests involve taking a small sample of your blood to measure hormone levels and look for: Thyroid disease Thyroid tumors. Problems with your parathyroid, adrenal glands, and pancreas.

31. cont Fine needle aspiration (FNA) biopsy of the thyroid; When an ultrasound shows a thyroid nodule, an FNA biopsy is often the next step. Your doctor takes a sample of the nodule using a thin needle. Thyroid ultrasound; A  thyroid ultrasound uses sound waves to take real-time images of your thyroid to look for abnormal lumps or nodules.

32. TREATEMENT Hormone replacement therapy:   This is used when a gland doesn't produce enough hormones. Examples include insulin for diabetes or thyroxine for hypothyroidism.  Medications to regulate hormones:   These drugs can either suppress the production of excess hormones (e.g., for hyperthyroidism or Cushing's syndrome) or stimulate hormone secretion.  Surgery:   This may be required to remove a tumor or part of a gland that is overproducing hormones.  Radiation therapy:   This can be used to treat certain tumors, such as pituitary gland tumors or to treat hyperthyroidism. 

33. TREATEMENT

34. PITUITARY GLAND

35. PITUITARY GLAND What is the pituitary gland? The pituitary gland (also known as hypophysis ) is a small, pea-sized gland located at the base of your brain below your hypothalamus. It sits in its own little chamber under your brain known as the sella turcica . It’s a part of your endocrine system and is in charge of making several essential hormones. Your pituitary gland also tells other endocrine system glands to release hormones.

36. cont A gland is an organ that makes one or more substances, such as hormones, digestive juices, sweat or tears. Endocrine glands release hormones directly into your bloodstream. Hormones are chemicals that coordinate different functions in your body by carrying messages through your blood to various organs, skin, muscles and other tissues. These signals tell your body what to do and when to do it.

37. cont The pituitary gland is divided into two main sections: the anterior pituitary (front lobe ) and the posterior pituitary (back lobe). Your pituitary is connected to your hypothalamus through a stalk of blood vessels and nerves called the pituitary stalk (also known as infundibulum ).

38. Pituitary gland

39. Pituitary gland

40. Which hormones does the pituitary gland make? The anterior lobe of your pituitary gland makes and releases the following hormones: Adrenocorticotropic hormone (ACTH or corticotrophin) . ACTH plays a role in how your body responds to stress. It stimulates your adrenal glands to produce  cortisol  (the “stress hormone”), which has many functions, including regulating metabolism, maintaining blood pressure, regulating blood glucose (blood sugar) levels and reducing inflammation, among others.

41. cont Follicle-stimulating hormone (FSH) In male, FSH stimulates sperm production. If you’re female, FSH stimulates the ovaries to produce estrogen and plays a role in egg development. This is known as a gonadotrophic hormone. Growth hormone (GH) . In children, growth hormone stimulates growth. In other words, it helps children grow taller. In adults, growth hormone helps maintain healthy muscles and bones and impacts fat distribution. GH also impacts your metabolism (how your body turns the food you eat into energy).

42. cont Luteinizing hormone (LH) . LH stimulates ovulation if you have ovaries and testosterone production if you have testicles. LH is also known as a gonadotrophic hormone because of the role it plays in controlling the function of the ovaries and testes, known as the gonads. Prolactin . Prolactin stimulates breast milk production (lactation) after giving birth. It can affect fertility and sexual functions in adults.

43. cont Thyroid-stimulating hormone (TSH) . TSH stimulates your thyroid to produce thyroid hormones that manage your metabolism, energy levels and your nervous system. The posterior lobe of your pituitary gland stores and releases the following hormones, but your hypothalamus makes them:

44. cont Antidiuretic hormone (ADH, or vasopressin) . This hormone regulates the water balance and sodium levels in your body. Oxytocin . Your hypothalamus makes oxytocin , and your pituitary gland stores and releases it. Oxytocin helps labor to progress during childbirth by sending signals to the uterus to contract. It also causes breast milk to flow and influences the bonding between parent and baby. Oxytocin also plays a role in moving sperm.

45. Functions of the pituitary gland The main function of your pituitary gland is to produce and release several hormones that help carry out important bodily functions, including: Growth Metabolism (how your body transforms and manages the energy from the food you eat) Reproduction Response to stress or trauma Lactation Water and sodium (salt) balance Labor and childbirth

46. DISORDERS OF THE PITUITARY GLAND ACROMEGALY occurs when the pituitary gland makes too much growth hormone, abnormal growth occurs. The abnormal growth starts in your hands, face, and feet, as soft tissue begins to swell. This rare disease affects mostly middle-aged adults. It can lead to severe illness and even death if not treated. In children before puberty, too much growth hormone causes a condition called gigantism . This leads to a large increase in height.

47. acromegaly

48. CAUSES Pituitary adenomas and acromegaly; Pituitary adenomas (tumors) are almost always benign (noncancerous). Most adenomas that cause acromegaly grow slowly, and you may not notice symptoms of excess GH for many years. genetics

49. CLINCAL MANIFESTATIONS

50. DIAGNOSTIC INVESTIGATIONS IGF-1 (Insulin-like Growth Factor-1):  This test measures the level of IGF-1, which is more stable throughout the day than GH. High levels suggest acromegaly .  Growth hormone suppression test.  This blood test measures your growth hormone level before and after you drink a type of sugar water called glucose. In people who don't have acromegaly , the glucose drink typically causes the growth hormone level to fall. But if you have acromegaly , your growth hormone level tends to stay high.

51. CONT Imaging tests.  Magnetic resonance imaging (MRI) can help pinpoint the location and size of a tumor in your pituitary gland. If no pituitary tumors are seen, you may need more imaging tests to look for other types of tumors. Your healthcare professional also may recommend X-rays of the hands and feet. These can help check for bone growth.

52. TREATMENT Acromegaly is treated with  surgery, medication, or radiation therapy, with surgery being the most common first-line treatment to remove the tumor. Surgical treatment Transsphenoidal surgery:  The preferred initial treatment for most patients, this involves surgically removing the pituitary tumor through the nose. 

53. Medical treatment Somatostatin receptor ligands : These are injectable medications that help lower growth hormone secretion and can also shrink the tumor.  Growth hormone receptor antagonist (e.g., pegvisomant ) : This daily injection lowers IGF-1 levels by blocking the growth hormone receptors, though it does not shrink the tumor itself.  Dopamine agonists (e.g., cabergoline ) : Often used in milder cases or in combination with other medications. 

54. TREATMENT CONT Radiation to shrink the size of the tumor. Often, this a treatment choice if surgery isn't an option. It's also an option if surgery can't remove the whole tumor or if medicine doesn't help enough. NB Some people need a mix of these treatments. Your treatment plan depends on factors such as: The location and size of your tumor. How serious your symptoms are. Your age and overall health

55. COMLICATIONS Acromegaly can increase your risk of: type 2 diabetes high blood pressure (hypertension) heart disease bowel polyps

56. THYROID GLAND

57. THYROID GLAND thyroid is a small, butterfly-shaped gland located at the front of your neck under your skin. It’s a part of your endocrine system and controls many of your body’s important functions by producing and releasing (secreting) certain hormones. The thyroid’s main job is to control the speed of  metabolism (metabolic rate), which is the process of how the body transforms the food ingested into energy . All of the cells in the body need energy to function. When the thyroid isn’t working properly, it can impact your entire body

58. PARTS OF THE THYROID There are two main parts of THE thyroid: the two halves (lobes) and the middle of the thyroid that connects the two lobes (thyroid isthmus). The thyroid is made of thyroid follicle cells ( thyrocytes ), which create and store thyroid hormone (mainly T3 and T4), and C-cells, which secrete the hormone calcitonin . The body converts inactive thyroid hormone T4 ( thyroxine ) into the active form, T3 ( triiodothyronine ), primarily in the liver and brain through enzymes called deiodinases .

59. cont NB C-cells, also known as parafollicular cells, are specialized cells in the thyroid gland that produce the hormone  calcitonin . Calcitonin's primary role is to help regulate blood calcium levels by inhibiting calcium release from bones and increasing calcium excretion by the kidneys.

60. FUNCTIONS OF THYROID GLAND As an endocrine gland, your thyroid makes and secretes hormones. Your thyroid produces and releases the following hormones: Thyroxine (T4) : This is the primary hormone your thyroid makes and releases. Although your thyroid makes the most of this hormone, it doesn’t have much of an effect on your metabolism. Once your thyroid releases T4 into your bloodstream, it can convert to T3 through a process called deiodination .

61. FUNCTIONS OF THYROID GLAND CONT; Triiodothyronine (T3) : Your thyroid produces lesser amounts of T3 than T4, but it has a much greater effect on your metabolism than T4. Reverse triiodothyronine (RT3) : Your thyroid makes very small amounts of RT3, which reverses the effects of T3. Calcitonin ; This hormone helps regulate the amount of calcium in your blood.

62. cont In order to make thyroid hormones, the thyroid gland needs iodine, an element found in food (most commonly, iodized table salt) and water. The thyroid gland traps iodine and transforms it into thyroid hormones. If you have too little or too much iodine in your body, it can affect the level of hormones the thyroid makes and releases

63. cont the thyroid hormones affect the following bodily functions: How your body uses energy (metabolism). Heart rate. Breathing. Digestion. Body temperature Brain development. Mental activity. Skin and bone maintenance. Fertility.

64. cont the thyroid gland and its hormones affect almost every organ system of your body, including: Your cardiovascular system:  the thyroid helps regulate the amount of blood your heart pumps through your circulatory system (cardiac output), heart rate and strength and vigor of your heart's contraction (contractility of the heart). The reproductive system : If the thyroid isn’t working properly, it can cause irregular menstrual periods and issues with fertility.

65. cont The  nervous system : When the thyroid isn’t working properly, it can cause symptoms that affect the nervous system, including numbness, tingling, pain or a sense of burning in the affected parts of your body. In addition, hypothyroidism can cause depression and hyperthyroidism can cause anxiety. The digestive system : the thyroid is involved with how food moves through the digestive system (gastrointestinal motility).

66. cont Can a person live without a thyroid? Yes, you can live without your thyroid. However, you’ll need to take hormone replacement medication for the rest of your life in order to stay healthy and prevent certain side effects and symptoms. Thyroid removal surgery, known as a thyroidectomy , is a common surgery that can treat certain thyroid conditions.

67. DISORDERS OF THE THYROID GLAND Thyroid diseases are split into two types: primary and secondary . In primary thyroid disease , the disease originates in the thyroid gland . In secondary thyroid disease , the disease originates in the pituitary gland

68. cont if you have a nodule on your thyroid that’s releasing excess amounts of thyroid hormones, it would be called primary hyperthyroidism. If a tumor in your pituitary gland is releasing excess amounts of thyroid-stimulating hormone (TSH), which then stimulates your thyroid to produce excess thyroid hormones, it would be called secondary hyperthyroidism

69. cont The four main conditions that affect your thyroid include: Hypothyroidism (underactive thyroid). Hyperthyroidism (overactive thyroid). Goiter (enlarged thyroid). Thyroid cancer.

70. Hyperthyroidism Hyperthyroidism (overactive thyroid) happens when the thyroid produces and releases more thyroid hormones than the body needs. This causes aspects of the metabolism to speed up. It is treatable.

71. CAUSES OF HYPERTHYROIDIDM Graves’ disease, an autoimmune condition. Thyroid nodules. Thyroiditis (inflammation of the thyroid). Postpartum thyroiditis (inflammation of the thyroid that happens after giving birth). Excess iodine in the blood from diet and/or medication. Over-treatment of hypothyroidism through medication. A benign (noncancerous) tumor in the pituitary gland.

72. CAUSES CONT Thyroid nodules : These are lumps or growths of cells in your thyroid gland. They can sometimes produce excess thyroid hormone. Consuming excess iodine : Consuming too much iodine (through foods or medications) can cause THE thyroid to produce more thyroid hormone TSH-releasing pituitary adenoma( thyrotropinoma ) : This is a growth in your pituitary gland that releases excess thyroid-stimulating hormone (TSH).

73. CLINCAL MANIFESTATION OF HYPERTHYROIDISM Rapid heart rate (tachycardia) and/or heart palpitations. Increased blood pressure. Shakiness, like hand tremors. Feeling anxious, nervous and/or irritable. Weight loss despite a regular or increased appetite. Diarrhea or more frequent pooping.

74. CONT Increased sweating and sensitivity to warm temperatures. Hair loss or brittle hair. Difficulty sleeping (insomnia). Menstrual period changes, like lighter or missed periods. Swelling and enlargement of your neck (goiter). Swelling or bulging of your eyes (thyroid eye disease).

75. DIAGNOSIS A physical exam : To start, your healthcare provider will do a physical exam to check for signs of hyperthyroidism, like an enlarged thyroid, rapid heart rate and warm, moist skin. Thyroid blood tests : Blood tests can check your thyroid hormone levels. When you have hyperthyroidism, levels of the thyroid hormones T3 and T4 are above normal and thyroid-stimulating hormone (TSH) is often (but not always) lower than normal. Thyroid antibody blood test : This test can check if Graves’ disease is the cause.

76. CONT Imaging tests : Various imaging tests of your thyroid can help diagnose hyperthyroidism and its cause. They include a radioactive iodine uptake (RAIU) test and scan and a thyroid ultrasound. Your provider will go over the options and processes with you and recommend the test they think is best

77. COMPLICATIONS Decreased libido Fertility problems in women Complications in pregnancy

78. HYPOTHYROIDISM Hypothyroidism (underactive thyroid disease) is a condition that happens when your thyroid gland doesn’t make or release enough hormone into your bloodstream.  As a result,  metabolism slows down. This can cause unintentional weight gain and make you feel exhausted all the time. Although weight gain and fatigue aren’t specific to hypothyroidism, a simple blood test can help check for this condition

79. TYPES OF HYPOTHYROIDISM There are four main types of hypothyroidism; Primary hypothyroidism  directly impacts the thyroid and causes it to make low levels of thyroid hormones. In turn, the pituitary gland makes more thyroid stimulating hormone (TSH). Autoimmune conditions like Hashimoto’s disease can cause it, or it can happen after thyroid gland surgery or radiation therapy. Primary hypothyroidism is the most common type .

80. cont Secondary hypothyroidism  occurs when you have an underactive pituitary gland (a pea-sized gland at the base of your brain). This rare type of hypothyroidism prevents the pituitary gland from sending TSH to your thyroid gland. Tertiary hypothyroidism  happens when the hypothalamus ( a structure in your brain that keeps your body in a stable state called homeostasis ) doesn’t make enough thyrotropin -releasing hormone (TRH). As a result, your pituitary gland can’t make enough TSH.

81. cont Subclinical hypothyroidism; also known as mild thyroid failure, happens when you have slightly elevated TSH levels, but all other thyroid hormone levels are within a typical range. Subclinical hypothyroidism usually goes away on its own in about three months. NB Hypothyroidism can affect anyone. It’s most common among females over age 60, particularly after menopause.

82. CAUSES OF HYPOTHYROIDISM Hashimoto’s disease is the most common cause of hypothyroidism. It’s an autoimmune disease so it happens when your immune system attacks your thyroid. Certain medications , including lithium, thalidomide and amiodarone . Conditions present at birth , like being born with no thyroid gland or a thyroid gland that doesn’t work properly. Iodine deficiency  (when you don’t have enough iodine in your body)..

83. CAUSES CONT Pituitary gland disorders , including noncancerous tumors. Thyroiditis  (inflammation of the thyroid that can happen after a viral illness or pregnancy). Genetic predisposition (a biological parent or sibling with the condition). History of thyroid surgery, including thyroid gland removal. Previous history of head and neck radiation therapy.

84. COMPLICATIONS OF HYPOTHYROIDISM With treatment, hypothyroidism complications aren’t very common. But left untreated, an underactive thyroid can lead to other health conditions like: Goiter Heart issues. Infertility. Miscarriage or birth defects. Peripheral neuropathy. Myxedema coma (a rare complication that can affect multiple organs and is life-threatening).

85. goitre

86. GOITRE Goiter is a condition where part or whole thyroid gland grows larger and is visible swelling on the neck. The entire thyroid can grow larger, or it can develop one or more small lumps called thyroid nodules. Goiter may be associated with an irregular amount of thyroid hormone in the body (hyperthyroidism or hypothyroidism) or with normal levels of thyroid hormone ( euthyroid ).

87. goitre

88. goitre

89. TYPES OF GOITRE Goiter can be classified in a few different ways, including the way by which it grows and if THE thyroid hormone levels are irregular or not. Classifications for goiter based on how it enlarges include: Simple (diffuse) goiter : This type of goiter happens when your entire thyroid gland swells and feels smooth to the touch. Nodular goiter : This type of goiter happens when a solid or fluid-filled lump called a nodule develops within your thyroid and makes it feel lumpy.

90. CONT Multinodular goiter : This type of goiter happens when there are many lumps (nodules) within the thyroid. The nodules may be visible or only discovered through examination or scans. Classifications of goiter based on thyroid hormone levels include: Toxic goiter : This goiter happens when your thyroid is enlarged and produces too much thyroid hormone

91. cont Nontoxic goiter : If you have an enlarged thyroid but normal thyroid levels ( euthyroid ), it’s a nontoxic goiter. In other words, you don’t have hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid).

92. CAUSES OF GOITRE Iodine deficiency:  Your thyroid needs iodine to produce thyroid hormone. If you don’t get enough iodine in your diet, your thyroid makes more cells (and grows) to try to make more thyroid hormone. Graves' disease:  Graves' disease is an autoimmune disease in which your immune system attacks your thyroid, causing it to grow larger. Graves’ disease also causes hyperthyroidism, which requires treatment.

93. CAUSES OF GOITRE CONT Hashimoto's disease:  This is an autoimmune disease that causes inflammation of your thyroid gland. Some people with Hashimoto's disease develop a compensatory increase in the thyroid gland's size. This type of goiter usually gets better on its own over time. Some cases of Hashimoto’s disease require treatment with thyroid hormone. Thyroid cancer:  Cancer of your thyroid gland often enlarges your thyroid.

94. CAUSES CONT Pregnancy : Human chorionic gonadotropin a hormone that a person produces during pregnancy, can cause their thyroid to grow. Thyroiditis :  Inflammation of the thyroid gland itself can cause your thyroid gland to grow. This can happen for several reasons. NB Sporadic goiters, in most cases, have no known cause. In some cases, certain drugs can cause this type of goiter. For example, the drug  lithium , which is used to treat certain mental health conditions, as well as other medical conditions, can cause this type of goiter.

95. Signs and symptoms A lump in the front of your neck, just below your Adam's apple. A feeling of tightness in your throat area. Hoarseness (scratchy voice). Neck vein swelling. Dizziness when you raise your arms above your head. Difficulty breathing (shortness of breath). Sweating without exercise or increased room temperature.