Galaganda (Goitre)

as per kayachikitsa syllabus Galaganda (Goitre)

1. ProfSriramChandraMishra
KayachikitsaDepartment
VYDSAyurvedMahavidyalaya,Khurja

2. INTRODUCTION
•GalgandaisaNanatmajaKaphajaRoga.(Ch.Su.20/1)
•TheAdhisthanaofGalagandaisRohini(sixthLayerofskin)
•Consideringthesite,sizeandfeatures,GALAGANDA cancomparedwith
GOITERwhichisassociatedwithTHYROIDrelateddisorders.
•Ifthereisoneswellinginthesideoftheneckregion(Gala)itiscalled
GALAGANDA (Goiter)andifthereisachainofswelling(Multiple)thenitis
calledGANDAMALA (Cervicallymphadenopathy).
(C. Chi. 12/79)

3. NIRUKTI/VYUTPAYYI(Etimology)
•Galaganda=Gala+Ganda
Gala:Kantha(Amarakosha)-Itmeansthepathwayoffood.
(Gala+Karane+Ap(Shabdakalpadruma),isderivedbytheunionof‘Gal’dhatu
and‘Ap’pratyayaorbytheunionof‘Gru’dhatuand‘Vyap’pratyaya).
Ganda:Itisderivedeitherbytheunionof‘Gadi’dhatuand‘Ach’pratyayaor
‘Gata’and‘Njantadda’sutrawhichmeansswellinginneckregionorenlargement
ofglandofneck(Shabdakalpadrum).

4. (SU. Ni 11/31, MN 38/1)
महान्तंशोथमल्पंवाहनुमन्यागलाश्रयम्।
लंबन्तं मुष्कवद् दृष््वा गलगंडं ववननर्दिशेत् (Y.R.)
PARIBHASHA(Definition)
•Galagandaismanifestedasabigorsmallsizeswellingwhichadheringfirmlyover
theneckregion(Gala)resemblesliketheshapeofascrotalsac(Muskavat).
PARYAYA(Synonym)
•Galasthana(गलगन्डोगलस्तनः-RajaNighantu)

5. NIDANA(Aetiology)
•NospecificcauseofGalgandahasbeenmentioned,butunderdifferent
topicsfewreferencesforGalgandaNidanaareavailable.
EtiologyforSothaRoga(GalgandadescribesuderShotharoga-Ch.Su.18/21)
EtiologyforMukhaRoga(GalgandadescribesuderMukharoga–A.H.U.21/69)
EtiologyforKaphaPrakopa(NanatmajaKaphajaRoga-Ch.Su.20/1)
HimvatprabhavariversmightgiverisetotheoccurrenceofGalaganda(SU.Su.
45/21)-Highlightspredominanceinhillyareas
ExcessiveuseofMadhurRasacanproduceGalganda(C.Su.26/41-1)
BheladescribedthatSleepdaandGalagandaaremorecommoninprachyadesa.
Dushtambu(contaminatedwater)andkrimidosha(Haritatritya-sthana,38/2)
Cold,dampwithdenselygrownlongtrees,waterstagnationandheavyrains
(KashyapKhilasthana25/10)

6. SAMPRAPTI(Pathogenesis)
•DuetointakeofMithyaharaviharas,Kaphagetsvitiatedreachesouteraspectof
neckregioncausinggraduallyswellingisknownasGalaganda.
•AccordingtoCharakonlyKaphadoshavitiatedwhereasSushruta,Madhavetc
toldsaboutVataandKaphadoshavitiation.
•VataandKaphawiththeMedasgettinglocalizedinthesidesoftheGala&
Manya(Throatregion),causingswellingwhichbecomingbiginsizeincourseof
timewiththeirownfeatures.
(SU. Su. 11/22)
(C. Su. 18/21)

7. Kapha / Vata
prakopa
↓
Prashara
in whole body
Khavaigunyaand
Sthanasamsrayaat
Gala &
Manyapradesha
Medodusti
Sothautpatti
(Swelling which
becoming big in size
in course of time)

8. SAMPRAPTIGHATAKA
•Dosha–Kapha,Vata
•Dushya–Meda,Rasa
•Srotas–MedovahasrotasandRasavahasrotas
•Srotodushti–Sanga
•Adhisthana–Gala/Manyapradesha
•Sadhyasadhyata–Yapya/Krichhrasadhya

9. BHEDA(Classification)
•CharakaattributesGalagandaonlytovitiatedkaphadoshabutSushruta
andVagbhatadescribethreetypesofGalaganda.
1.Vataja
2.Kaphaja
3.Medoja
•NoonetoldaboutPITTAJAverity,ThismaybeduetoVyadhiswabhava.

10. LAKSHANA(Symptoms)
Generalfeature
•Bigorsmallsizeswellingwhichadheringfirmlyovertheneckregion
(Gala)resemblesliketheshapeofascrotalsac(Muskavat).
(SU. Ni 11/31, MN 38/1)

11. Specificfeatures
VATAJAGALAGANDA
•Toda(PrickingPain)
•Coveredwithnetworkofblackveins
•Tumoriseitherblackorslightlyredincolour
•Withpassageoftimewhenitcombineswithfatandgrowsinsize
Becomesveryunctuous(Atisnigdha)andpainless(Aruja)
Sometimesitbecomescoarse/rough(Parusya)
Growsslowly(Chiravriddhi)
Suppurate/Formspuswithoutanycause(PakamYadruchhya)/Rarely
Suppurate(PakamKadachita)
Givesrisetobadtasteinmouth(Ashyavairasya)
Severedrynessofpalateandthroat(Talu-Galaprasosha)
(SU. Ni. 11/23-24)

12. Specificfeatures
KAPHAJAGALAGANDA
•Immovable
•Samecolourwiththebody
•Slightpain
•Profounditching
•Coldtotouch
•Biginsize
•Growsslowly
•Formspusslowly
•Sometimes,accompaniedwithmildpain
•Sweettasteinmouthandcoatingofpalateandthroat
(SU. Ni. 11/25)

13. Specificfeatures
MEDOJAGALAGANDA
•Unctuous
•Soft
•Pale
•Offensiveodor(Anisthagandho)
•Nopain
•Severeitching
•Hangslooselikeapitchergourdwithasmallbase
•Decreaseorincreaseinsizeaccordingtodecreaseorincreaseofthebody
•Unctuousnessofthemouth
•Alwaysproducesasecondsoundofvoice
(SU. Ni. 11/26-27)

14. SADHYASADHYATA (Prognosis)
•Sadhya–Galaganda(Simple)
•Asadhya–GalagandawithPinasa,Parsvasula,Kasa,Jvara,Chardi
•Rejectedcase-Galagandapatienthavingdifficultybreathing,
flaccidityofwholebody,diseaseduratioofmorethanayear,suffering
fromaorexia,isemaciatedandhashoarsenessofvoice.
(C. Chi. 12/79)
(SU. Ni. 11/26-27)

15. CHIKITSA(Management)
Treatmentprinciple
(C. Chi. 21/139-140)
•Kaphajagalaganda–TreatlikeVisarpajagranthi
•KaphanubandhiVatajagalaganda–Ghrita,Ksheera,Kashaya
Vamanakarma(C.Si.2/10),Virechanakarma(C.Si.2/13),Sirovirechana(C.Si.
2/22),agnikarma(C.Chi.25/101-102)alsoindicatedinGalagada.
ThesiteofsiravyadhaforGalagandaisUrumula.(उरुमूलंसंभिताम्गलगण्डेShaChi8/17)

18. Singledrugs
•Kanchanara-Freshbarkgrindedwithtandulodakaandshunthiusedinternally(S.Y.41/18)
•Jalkumbhi(WaterLettuce/Pistiastratiotes)-Pasteappliedovertheswellingoftheneck,
Jalakumbhibhasmagivenwithgomutra(SiddhaYoga41/8)
•Shigru-Shigruseedspastewithnichulaisappliedlocally(SiddhaYoga41/3)
•Varuna-DecoctionofVarunarootisgivenwithhoney(SiddhaYoga41/27)
•Aaragvadha-RootbarkgrindedwithricewaterusedasNasyaorLepa(SiddhaYoga41/23)
•Nirgundi-RootofNirgundiisgrindedwithwaterandusedforNasya(SiddhaYoga41/24)
•Ashwagandha
•Guggulu
•Brahmi
•Apamarga
•Tamrabhasma
•Silajeet
•Trikatu

19. Compoundmedicines
•Guggulu-KanchanarGuggulu,TriphalaGuggulu(Gadnigraha4/392)
•Phanta–Panchakolachuraphanta
•Vati-Vriddhivadhikavati,Lavangadivati,Arogyavardhinivati
•Kashaya–Amritottarakashayam
•Churna–TrikatuChura
•Lauha/Mandoora-ShothariLoha,Vajravatakamandoora(AFI)
•Modaka-Abhayadimodaka
•Rasa–Srinripattivallabnarasa,Gandamalakandanarasa
•Taila–Bhringaamalakyaditaila
•Lepa–Sarsapadipralepa

21. •Itisabutterfly-shapedendocrineglandlocatedinthelowerfrontoftheneck.
•Thyroidhormonescontrolmetabolismandalsoregulatevitalbodyfunctions.
•Thyroidhormoneimbalancescanleadtolife-threateningconditionssuchas
myxedemacoma(dangerouslylowthyroidhormones)andthyroidstorm
(excessivethyroidhormoneconcentration).

22. Thethyroidglandconsistsoftwotypesofcells
IODINEdoesnotproducedinbody,soartificiallyaddedtodiet(Iodizedsalt)
•Follicularcells→Producetriiodothyronine(T3)andthyroxine(T4/
tetraiodothyronine)bythehelpofiodine.
•Parafollicularcells→Producethyrocalcitonin/Calcitoninwhich
playsaroleincalciumhomeostasis.

23. :

24. •Thyrotropin-releasinghormone(TRH)
•Thyroid-stimulatinghormone(TSH)
•Thyroidhormones(freeandbound):
•Thyroxine/tetraiodothyronine(T
4):mostlyaprohormonebutwith
somehormonalactivity
•Triiodothyronine(T
3):themorebioactiveform,convertedfromT
4

25. •Thethyroidhormonesarereleasedintothebloodstreamandtransportedthroughoutthebody.
•Most(99.95%ofT4and99.5%ofT3)areboundtoserumproteinssuchasthyroxine-binding
globulin(TBG),transthyretin(TTR),albuminandlipoproteins.
•Asmallerportioncirculatesasfreehormonesthatentercellsandtriggermetabolism.
•T4isthoughttobeapro-hormonetothemoremetabolicallyactiveT3.T4isconvertedtoT3in
tissuesasrequiredbydeiodinaseenzymes.
•ForT4,approximately75%isboundtothyroxine-bindingglobulin(TBG),10%totransthyretin
(TTR),12%toalbumin,and3%tolipoproteins.
•Aminimalamount,about0.02%,ofT4intheserumisfree,orunbound.
•ForT3,approximately80%isboundtoTBG,5%toTTR,and15%toalbuminandlipoproteins.
•About0.5%ofT3intheserumisfree.
It is the free T3and T4concentrations in the blood that are responsible for biologic activity.

26. •SerumTSHconcentration:
VerysmallchangesinserumfreeT4stimulateverylargechangesinTSH.
AhighTSHlevelindicatespoorthyroidglandfunctionorhypothyroidism
AlowTSHtypicallyindicatesanoveractivethyroidhormone,or
hyperthyroidism.
Normalranges-0.4to5.0mlU/L.

27. •SerumTotalT4concentration:
Thismeasuresbothboundandunbound(free)T4.
AhighserumT4mayindicatehyperthyroidismwhilealowlevelmayindicate
hypothyroidism.
Pregnancyororalcontraceptives,T4levelswillbehigher.
Criticalillness,corticosteroidsandmedicinethattreatasthma,arthritis,andother
healthproblems,canlowerT4levels.
Normalranges-4.6to11.2mcg/dL(60to145mmol/L).
•SerumFreeT4concentration:
ThismeasuresT4unboundtoproteins
AlowfreeT4willindicatehypothyroidism
AhighfreeT4willindicatehyperthyroidism.

28. •SerumTotalT3concentration:
AhighT3levelmayhelpconfirmadiagnosisofhyperthyroidismiftheT4levelis
normal.
Thenormalrange-75to195ng/dL(1.1to3nmol/L)
•T3resinuptake(T3RU)
Thisisanindirectmeasureofserumthyroidhormonebindingcapacity.
•FreeT4index(FT4I):
ThisisderivedfromT4andT3RUandindicateshowmuchfreeT4ispresent
comparedtoboundT4.
FT4IcanhelpdetermineifahighT4levelisduetoabnormalamountsofTBG.

29. Hyperthyroidism-Productionoftoomuchthyroxinehormone.
Hypothyroidism-Productionoftoolittlethyroidhormone
Goiters-Agoiterisabulgeintheneck.
Solitarythyroidnodules-Nodulesorlumpswithinthethyroiddueto
swollentissue,anovergrowthofnormalthyroidtissueorcyst.
Thyroidcancer-Malignantcellsforminthetissuesofthethyroidgland.
Thyroiditis-Inflammationofthethyroidleadingtothyroid’scellsdeath,

30. •Theterm“goitre”simplyreferstotheabnormalenlargementofthethyroidgland
thatcausesalumpinthefrontoftheneck.
•Apainlessthyroidmass(Lump)whichismobile(moveupanddown)with
swallowing
•Agoitercanmeantfor
Allthethyroidglandisswollenorenlarged,
Oroneormoreswellings/lumpsdevelopinapart
Orpartsofthethyroidgland.

31. •Iodinedeficiency:mostcommoncauseworldwide
•Biosyntheticdefects
•Radiationexposure
•Autoimmune:
 Graves’disease
 Hashimoto’sthyroiditis
 Subacutelymphocyticthyroiditis
 Postpartumthyroiditis
 Granulomatousthyroiditis
•Infiltrativedisease:
 Riedel’sthyroiditis
 Sarcoidosis
 Histiocytosis
 Cystinosis
 Amyloidgoiter
•Goitrogeningestion:
 Lithium
 Iodine
 Food(cassava,millet)
•Thyroidmasses:
 Cyst
 Adenoma
 Carcinoma

32. •Iodinedeficiency(mostcommoncause,Goiterisalsoknownasiodinedeficiencydisease/IDD)
Thyroidglandneedsiodinetomakethyroidhormone.Deficiencyofiodinecauses
hypothyroidism.Consequently,TSHstimulatesthethyroidglandtoproduceenoughthyroid
hormone.Tocapturealltheiodinetomaketherightamountofthyroidhormone,thethyroid
glandgetslarger(Hyperplasia).
•Biosyntheticdefects
InbornerrorsofthyroidhormonesynthesiscausesCongenitalhypothyroidism
Thyroidhormoneinsensitivity-Thethyroidhormonelevelsareelevatedbutthethyroid
stimulatinghormone(TSH)levelisnotsuppressed,
Pregnancy-Humanchorionicgonadotropin(HCG),producedduringpregnancy,maycause
thyroidglandtoenlargeslightly.
•Radiationexposure
Medicalradiationtreatmentstotheheadandneck

33. •Autoimmune:
Gravesdisease-Overactivethyroid/hyperthyroidism-InGraves'disease,
Autoantibodies(TSHR-Ab)producedbytheimmunesystemmistakenlyattackthe
thyroidgland,causingactivationoftheTSH-receptor(TSHR)whichstimulates
thethyroidglandtoproduceexcessthyroxine.Thisoverstimulationcausesthe
thyroidtoswell.
Hashimotothyroiditis-Underactivethyroid/Hypothyroidism-Hashimoto’s
thyroiditisisanAutoimmunediseaseinwhichthethyroidglandisgradually
destroyedcausinghypothyroidism.Sensingalowhormonelevel,pituitarygland
producesmoreTSHtostimulatethethyroid,whichthencausesthe
glandtoenlarge.

34. •GoitrogenIngestion
Goitrogensaresubstancesthatimpairthyroidhormonesynthesis,eitherby
inhibitingiodineuptake(cyanogenicgoitrogens)orbyinhibitingorganicbinding
ofiodinebythethyroidglands(goitrogensofthethiouraciltype).
Goitrogensactuallyactlikeanantithyroiddrug,consumingtheminhigher
quantitiescanleadtoareductioninthelevelsofthyroidhormones.
Example–Lithium,Iodine,Food(cassava,millet)
Food-Gluten(Pasta,bread,beer,cereals,andotherbakedgoods),HumbleCabbage,
Isothiocyanates&itsCruciferousfriends(cauliflower,Brusselssprouts,turnips,
cabbage,broccoli,andkale),Millets,Radish,Soybeans,Greentea,
Potentiallygoitrogeniccompounds-spinach,pinenuts,millets,peanuts,almonds,
walnuts,peaches,sweetpotatoes,sorghum,strawberries,andsweetcorn

35. •Thyroidmasses:Canbesolid(orcellular),cystic(fluidfilled),oracombinationof
both.
Thyroidcysts(e.g.,thyroglossalcyst)-Multinodular/Solitarythyroidnodules
(Uninodular)
Thyroidcarcinomas–benignormalignant
Thyroidadenomas/Pituitaryadenoma-Hypersecretionofthyroidstimulating
hormone(TSH),almostalwaysbyapituitaryadenoma(non-cancerous/
benigntumor)

36. Classificationbasedonetiology:
•Physiologicalgoiter:Goiteroccurringduetoincreasedmetabolicdemandofthyroid
hormones(duringpregnancyorpuberty).
•Pathologicalgoiter:Goiteroccurringasaresultofthediseasesaffectingthethyroid
glande.g.neoplasticorinflammatoryconditions.
Classificationbasedonepidemiology:
•Familialgoiters:Goiteroccurringasaninheriteddefectofthyroidhormonesynthesis.
•Endemicgoiters:Thyroidenlargementobservedinasignificantnumberofpopulationin
aparticularlocality.
•Sporadicgoiters:Goiteroccuringsporadically.

37. Classificationbasedonanatomy:
•Cervicalgoiter:Goitersituatedontheanterioraspectoftheneck.
•Retrosternalgoiter:Goitersituatedbehindthesternumandextendingdownwards.
•Intrathoracicgoiter:Goiterextendingintothoraciccavity.
Classificationbasedonfunction:
•Toxicgoiter:Goiterassociatedwiththyroidhyperfunction(hyperthyroidism)
•Non-toxicgoiter:Goiterassociatedwiththyroidhypofunction(hypothyroidism)or
normalthyroidfunction(Euthyroid)
Classificationbasedonmorphology:Accordingtothetextureofthethyroidgland:
•Diffusegoiter-wheretheentirethyroidglandswellsandfeelssmoothtothetouch
•Nodulargoiter:Solitarynodulargoiter,Multinodulargoiter

38. Classificationbasedonpathology:
•Simplegoiter •Toxicgoiter •Neoplasticgoiter
•Inflammatorygoiter •Miscellaneous(otherraretypes)
Classificationbasedonphysicalexamination/palpation(WHO)
1.Grade0-Nopalpableorvisiblegoiter.
2.Grade1-Agoiterthatispalpablebutnotvisiblewhentheneckisinthenormalposition
(i.e.thethyroidglandisnotvisiblyenlarged).Nodulesinathyroidthatisotherwisenot
enlargedfallintothiscategory.
3.Grade2-Aswellingintheneckthatisclearlyvisiblewhentheneckisinanormalposition
andisconsistentwithanenlargedthyroidglandwhentheneckispalpated.

40. •Initiallyasymptomatic,asmostgoitersgrowslowly.
•Swellingofthethyroidglandwhichcausesalump.
•Presentationassociatedwiththyroiddysfunction:
Hypothyroidism:fatigue,coldintolerance,swelling,constipation
Hyperthyroidism:weightloss,palpitations,dyspnea,tremors
•Presentationassociatedwithmass/obstructiveeffect:
Exertionaldyspnea:
Mostcommonobstructivesymptom
Compressionoftrachea
Trachealdiameterof<5mm→stridororwheezingoccurs

41. •Neckdiscomfort(fromtheenlargingmass)
•Hoarsevoicefromrecurrentlaryngealnervecompression
•Dysphagiaordifficultyswallowingfromcompressionoftheesophagus
•Phrenicnerveparalysis
•Horner’ssyndromefromcompressionofcervicalsympatheticchain
•Jugularveincompression
•Superiorvenacavasyndrome
•Tenderness/pain(granulomatousthyroiditis)
•Accompanyingorbitopathy,dermopathy(Graves’disease)
•Hardthyroidglandwithextensivefibrosisbeyondthyroidarea(Riedel’sthyroiditis)

42. •DeterminehistoryofAutoimmunedisease,Iodineintake,Medications,Headandneck
radiation,Thyroiddiseaseandassociatedsyndromesinfamilymembers.
•Palpationofthethyroidglandmorphology,consistency,size,andtendernessandsearch
forsignsofmalignancy(Severityofgoitergraded0–2(WHO)
•Pembertonmaneuver(worsensobstructivesymptoms):
•Havethepatientholdthearmsabovetheheadfor1minute.
•Thismaneuverpushesthethyroidglandintothethoracicinlet.
•Theresultsareconsideredpositiveifthepatient’sneckveinsdistendoriffacial
plethora,cyanosis,ordifficultyinswallowingoccurs.

43. Thyroidfunctiontests:TSHfollowedbyFT
3/FT
4
•Toxicgoiter:lowTSH,↑T
3/T
4
•Nontoxicgoiter:NormalTSH
•Hypothyroidgoiter:ElevatedTSH,↓FT
3/FT
4
ThyroidAntibodies
Thyroidperoxidase(TPO)antibodies:Suggestspresenceofautoimmunedisorder.
Thyrotropinreceptorantibodies(TRAbs):measuredinhyperthyroidism(TRAbare
antibodiesthatbindtothereceptorsonthyroidcellsnormallyactivatedbyTSH.InGraves’
disease,theantibodycalledthyroidstimulatingimmunoglobulin(TSI)bindstotheTSH
receptorandmimicstheactionofTSH.Thiscausesconstantstimulationofthethyroid
gland)

44. Ultrasoundscanofneck
Thyroidasymmetry,firmconsistencyortenderness
Rapidgrowth
Nodule(s)
Nondiagnosticexamandlabfindings
Radioactiveiodineuptake(RAIU)scan
Assessmentofhyperthyroidismorsubclinicalhyperthyroidism
Canhelpdifferentiatehyperthyroidstates(e.g.,Graves’diseaseversusmultinodulargoiterwith
autonomy)
CTorMRI:
Inpatientswithobstructiveorsubsternalgoiter
Inthosewithfeaturessuspiciousformalignancy
Assessmentofthethyroidgland,massesornodules,andthesurroundingstructures

45. Biopsywithfine-needleaspiration
Prominentnodules(≥1.5cm)
Firmthyroidgland
Riskfactorsformalignancy:Youngage,Historyofradiationtotheheadorneck,Family
historyofthyroidcancer,Familialadenomatouspolyposis(FAP)orotherassociated
syndromes,Firm,solid,and/orcoldnodules.
UrineexaminationforIODINE
Iodinedeficiencyisdefinedasamedianurinaryiodineconcentrationlessthan100μg/L
inanonpregnantpopulation,or<150μg/Linapopulationofpregnantwomen.
Iodinedeficiencyisdiagnosedacrosspopulationsandnotspecificallyinindividuals.
Sinceiodineisreleasedfromthebodythroughtheurine,thebestwaytodetermine
iodinedeficiencyacrossalargepopulationistomeasuretheamountsofiodineinurine
samples.

46. Goitertreatmentdependsonthesize,signsandsymptomsandtheunderlyingcause.
Iodinedeficiencygoiter
Multivitamincontaining150μgiodineperday.
Addiodizedsalttofoodregularlyduringcooking(oneteaspoonofiodizedsalt
containsapproximately250μgiodine)
Injectionsofiodizedoilareoccasionallyusedinseverelyiodinedeficientregions
oftheworldwherewidespreadiodizedsaltuseisnotpossible.
Surgery:Totalthyroidectomy,withlifelongthyroxinesupplementation

47. Nontoxicgoiter
Thyroxine/Levothyroxine(Brandname-Eltroxin)
Iodinereplacementifneeded
Surgery(totalornear-totalthyroidectomy)
Toxicgoiter
Beta-blockersforsymptomaticrelief.
Antithyroiddrugs(Carbimazole,methimazole,Propylthiouracil(PTU)
Radio-iodinetherapy
Surgery:Totalthyroidectomywithlifelongthyroxinesupplementation

48. Inflammatorygoiter
Autoimmune:Steroid,Antithyroiddrug,Thyroxinesupplementation
Bacterial:Nonspecific–Antibiotic,Specific-AntiTBtherapy
Viral:Usuallyselflimitingonlysupportivetreatment
Nodulargoiter
Solitarynodulargoiter:Hemithyroidectomy
Multinodulargoiter:Thyroidectomywithlifelongthyroxinesupplementation
Neoplasticgoiter
Follicular/papillary/medullarycarcinoma:Totalthyroidectomywithlifelong
thyroxinesupplementation
Anaplasticcarcinoma:Isthmasectomy+externalbrimradiotherapy

49. •Adults-1.6mcg/kgorallyonceaday(roundedtothenearest25mcg).
Over50yrsorwithheartdisease,maystartonalowerdose(25to50
mcg/day)
•Thyroxinetakenonanempty(morning).Nofood,milk,orteashouldbe
taken1hourbeforeand2hoursaftertakingthismedicine.
•Itmaytake6to8weekstogetthefulleffect.
•Sideeffect:Angina,AtrialFibrillation,↓BoneDensity,vomitingor
diarrhoea,Headaches,Feelingrestlessorexcitable,orproblemssleeping,
Flushingorsweating,Musclecramps
(Brand name -Eltroxin)

50. IndicatedforLarge(>80–100mL),Growinggoiters,Goiterscausing
obstruction.
Typesofthyroidsurgery
•Totalthyroidectomy
•Subtotalthyroidectomy
•Near-totalthyroidectomy(Dunhillprocedure)
•Lobectomy

51. THANK YOU