9.2 NODULAR GOITRE
The
large majority of these goitres produce a cosmetic defect or cause pressure
symptoms (respiratory distress, dysphagia). Some, however, may present with
symptoms of excess thyroid hormone (Toxic Goitre)
The
symptoms in toxic goitre are similar to those of Grave’s Disease, except for
those due to disturbed immune system which are absent. A single nodule in the
thyroid can also produce excess hormones and present with all the clinical
features of toxicity.
The
diagnosis is established by measuring thyroid hormones in the serum and a scan
helps to establish the autonomously functioning nodule (AFN)
Treatment
of surgery after control of the hyperfunction of the thyroid with Neomercazole.
9.3 Goitre and Carcinoma
The
risk of Carcinoma developing in a multinodular goitre is small.
However,
carcinoma can co-exist with a multinodular goitre (4-17%).
In
cases of solitary nodule Fig. 31.6 is viewed by surgeons with greater
suspicion, since it represents a focal replication of thyroid cells. An I131
scan and a fine needle aspiration cytology may further help to come to a
decision. In most cases, a hemithyroidectomy is recommended
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