Pathophysiology of Nontoxic Nodular Goiter [PDF]

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Pathophysiology of Non-toxic Nodular Goiter Precipitating Factors: Diet History of Radiation Regular intake of substances (Goitrogens)



Predisposing Factors: Age Gender Genetics Geographic



Decreased/Suppression of synthesis of thyroid hormones



Decreased T4 and T3 in the body



Negative feedback: Increased production of TSH



Heterogeneous growth of thyroid follicles



Ischemic necrosis of expanding follicles



Development of nodules



Thyroid architecture loses uniformity



Gradual enlargement of the Thyroid Gland (Nontoxic Nodular Goiter)



Functional autonomy of thyroid follicles



TSH receptor gene mutation



Toxic Multinodular Goiter



May lead to Thyrotoxicosis



Thyroid Storm



Heart Failure



Death



 Visible and palpable mass (Goiter)



Pressure on anterior neck structures



Venous outflow obstruction of the head and neck



 Facial plethora  Engorgement of neck veins



Pressure on esophagus



 Dysphagia



Pressure on trachea



 Dyspnea  Coughing  Wheezing



Pressure on recurrent laryngeal nerve



Treatment:  Thyroidectomy  Radioactive Iodine therapy  Levothyroxine Therapy



 Hoarseness