treatment of Goiter

treatment of goiter power point 2018 /al_nahrain college of med

1. Treatment of goiter By : haneen ayad

2. Treatment for a goitre can include medication, hormone therapy and surgery. In general The treatment they receive will depend on: the size of the goitre the symptoms the goitre is causing whether they have any underlying thyroid condition If goitre is interfering with breathing or swallowing and it hasn't responded to other forms of treatment,they need surgery to remove part or all of thyroid gland. This procedure is known as a thyroidectomy .

3. Observtion in : Small goiter Euthyroid Asymptomatic  

4. overactive thyroid gland( hyperthyroidisim ) The main treatments are: medication radioiodine treatment surgery

5. Medication called thionamides are a common treatment for an overactive thyroid. These stop thyroid producing excess hormones. The main types used are  carbimazole and propylthiouracil . And use b-blocker to quickly relieve the symptoms in the meantime.

6. Side effects During the first couple of months, some people experience the following side effects: feeling sick headaches aching joints an  upset stomach an itchy rash A less common but more serious side effect is a sudden drop in white blood cell level  ( agranulocytosis ) , which can mean very vulnerable to infections.

7. Antithyroid drugs: Either blocks the iodine binding to tyrosine and decrease antibody titers ( carbimazole ) Or block iodine binding and prevent conversion of T4 to T3 ( propylthiouracil ) (inhibit hormone synthesis )

8. CMZ , usually 20-40mg daily, PTU In hyperthyroidisim (300_450mg/day) Maintenance (100_150 mg/day) In thyrotoxic crisis initialy ( 200_300mg /day) Maintenance (100_150mg/day) In graves disease (50_150mg/day) Maintenance 50mg/12h Then taper and discontinoue if TSH is normal

9. and start taking levothyroxine (usually 50-150mcg daily) to replace the thyroid hormone that body would normally produce.

10.  treatment for a child with an over-active thyroid gland. The usual dose used is CMZ 0.5-1mg per kg bodyweight per day or PTU 5-10mg per kg bodyweight per day. PTU is not recommended for children unless they are allergic to CMZ as there is an increased risk of liver damage.

11. Some important points…. * normally be referred to an endocrinologist *important to take tablets every day. *Forgetting to take tablets will affect blood test results and health *If develop a sore throat, mouth ulcers or unexplained fever , immediately and ask for a white blood cell count *If notice yellowing of the eyes or skin should ask for a liver enzyme test

12. Radioiodine treatment is where  radiation  is used to damage your thyroid, reducing the amount of hormones it can produce. It's a highly effective treatment that can cure an overactive thyroid .  given a drink or capsule that contains a low dose of radiation, which is then absorbed by thyroid. Most people only require a single treatment .  take a few weeks or months for the full benefits to be felt, so may need to take one of the medications mentioned above for a short time.

13. avoid prolonged close contact with children and pregnant women for a few days or weeks women should avoid getting pregnant for at least six months men shouldn't father a child for at least four months Radioiodine treatment isn't suitable  for pregnant ,breastfeeding or overactive thyroid that causing severe  eye problems .

14. Surgery  surgery to remove all or part of  thyroid may be recommended . in  severely swollen (a large  goitre )   in severe eye problems resulting from an overactive thyroid In other therapy are not practical or ineffective Removing the entire thyroid gland is normally recommended, as this cures an overactive thyroid and means there's no chance of the symptoms coming back. But  will need to take medication for rest life to make up for not having a thyroid – these are the same medications used to  treat an underactive thyroid .

15. indications Thyroid cancer Toxic  thyroid nodule  (produces too much thyroid hormone) Multinodular   goiter  (enlarged thyroid gland with many nodules), especially if there is compression of nearby structures Graves' disease , especially if there is  exophthalmos  (bulging eyes) Thyroid nodule, if  fine needle aspirate  (FNA) results are unclear

16. Types Hemithyroidectomy —Entire isthmus is removed along with 1 lobe. Done in benign diseases of only 1 lobe. Subtotal thyroidectomy —Removal of majority of both lobes leaving behind 4-5 grams (equivalent to the size of a normal thyroid gland) of thyroid tissue on one or both sides—this used to be the most common operation for multinodular goitre .

17. Partial thyroidectomy — Removal of gland in front of trachea after mobilization. Done in nontoxic MNG. Its role is controversial. Near total thyroidectomy —Both lobes are removed except for a small amount of thyroid tissue (on one or both sides) in the vicinity of the recurrent laryngeal nerve entry point and the superior parathyroid gland. Total thyroidectomy —Entire gland is removed. Done in cases of papillary or follicular carcinoma of thyroid, medullary carcinoma of thyroid. This is now also the most common operation for multinodular goitre .

18. Complications Hypothyroidism  in up to 50 % of patients after ten years . Laryngeal nerve  injury in about 1% of patients, in particular the  recurrent laryngeal nerve : Unilateral damage results in a hoarse voice. Bilateral damage presents as laryngeal obstruction after surgery and can be a surgical emergency: an emergency  tracheostomy  may be needed. Recurrent Laryngeal nerve injury may occur during the ligature of the inferior thyroid artery.

19. Hypoparathyroidism  temporary (transient) in many patients, but permanent in about 1-4% of patients Anesthetic  complications Infection  (at about a 2% rate. Drainage is an important part of treatment . Stitch  granuloma Chyle  leak Haemorrhage / Hematoma  (This may compress the airway, becoming life-threatening.) Removal or devascularization of the parathyroids ( hypoparathyroidisim )

20. Minimally invasive modalities: Endoscopic subtotal thyroidectomy Embolization of thyroid arteries Plasmaphoresis Percutaneous ethanol injection in to toxic nodule L- carnitine supplementation may improve symptoms and may prevent bone loss

21. Underactive thyroid (hypothyroidism)  is usually treated by taking daily hormone replacement tablets called levothyroxine . Should have regular  blood tests  until the correct dose  of levothyroxine is reached.  . Treatment was initiated with thyroxine 50 μg /d if there was a history of cardiac disease and 100 μg /d otherwise. Blood pressure, weight and TSH, fT4, fT3, cystatin C and creatinine were measured once a week. Thyroxine dose was increased by 25 μg every 8 weeks until TSH normalised .

22. taking the correct dose will do blood test once a year to monitor hormone levels .  should take 1 tablet at the same time every day . The effectiveness of the tablets can be altered by other medications, supplements or foods, so they should be swallowed with water on an empty stomach, and should avoid eating for 30 minutes afterwards . If forget to take a dose, take it as soon as remember , if this is within a few hours of usual time. If don't remember until later than this, skip the dose and take the next dose at the usual time, unless advised otherwise by doctor .

23. Side effects usually only occur if you're taking too much levothyroxine . This can cause problems including sweating,  chest pain ,  headaches ,  diarrhoea  and vomiting . In most cases, suppressing thyroid-stimulating hormone (TSH) using high dose thyroid replacement therapy should be avoided because it carries a risk of causing adverse side effects, such as  atrial fibrillation ,  strokes ,  osteoporosis  and fracture.