Goitre

Question 1

What is goiter?

Answer 1

Enlargement of the thyroid gland regardless of the cause.

Question 2

What are the types of goiter?

Answer 2

Simple goiter toxic goiter neoplastic goiter and inflammatory goiter (thyroiditis).

Question 3

What is simple goiter?

Answer 3

Enlargement of the thyroid gland without toxic neoplastic or inflammatory manifestations.

Question 4

What is the most common type of goiter?

Answer 4

Simple goiter.

Question 5

Which gender is more affected by simple goiter?

Answer 5

Females.

Question 6

What are the types of simple goiter?

Answer 6

Simple diffuse goiter and simple nodular goiter.

Question 7

What is simple diffuse goiter?

Answer 7

Diffuse enlargement of the thyroid gland.

Question 8

What is simple nodular goiter?

Answer 8

Enlargement of the thyroid gland with a nodular surface.

Question 9

What are the causes of simple goiter?

Answer 9

Iodine deficiency stress factors and goitrogens.

Question 10

How does iodine deficiency cause goiter?

Answer 10

It decreases thyroid hormone synthesis leading to increased TSH which enlarges the gland.

Question 11

What are examples of stress factors causing goiter?

Answer 11

Puberty pregnancy lactation chronic anxiety and stress.

Question 12

What are goitrogens?

Answer 12

Substances that decrease thyroid hormone levels such as anti-thyroid drugs and thiocyanates.

Question 13

How does goiter develop?

Answer 13

Low T3 and T4 lead to increased TSH causing thyroid gland enlargement hyperplasia and increased thyroid follicle formation.

Question 14

What happens after the cause of goiter is relieved?

Answer 14

The gland undergoes involution and may return to normal.

Question 15

What is physiological goiter?

Answer 15

A reversible condition where thyroid follicles return to normal size and number.

Question 16

What is colloid goiter?

Answer 16

A condition where excessive involution leads to increased colloid content inside the follicles with flattened lining cells.

Question 17

What is simple nodular goiter?

Answer 17

Alternating hyperplasia and involution cause capillary rupture minor hemorrhages fibrosis and nodule formation.

Question 18

Can the thyroid return to normal in simple nodular goiter?

Answer 18

No because of fibrosis and nodule formation.

Question 19

What are the general symptoms of simple goiter?

Answer 19

No toxic or malignant symptoms.

Question 20

What are the local symptoms of simple goiter?

Answer 20

Neck swelling and compression symptoms like dyspnea dysphagia and discomfort in large goiters.

Question 21

What are the general signs of simple goiter?

Answer 21

No toxic or malignant signs.

Question 22

What are the local signs of simple goiter?

Answer 22

Butterfly swelling in the lower neck moving with deglutition smooth surface in diffuse goiter and nodular in nodular goiter.

Question 23

What are the types of nodules in simple goiter?

Answer 23

Single nodule (solitary thyroid nodule) or multiple nodules (multi-nodular goiter).

Question 24

What are the characteristics of nodules in simple goiter?

Answer 24

Firm fleshy or cystic consistency with no pulsations or thrill.

Question 25

What investigation confirms the diagnosis of goiter?

Answer 25

Neck ultrasound.

Question 26

What does neck ultrasound assess in goiter?

Answer 26

Thyroid gland size nodule type (diffuse or nodular cystic or solid) vascularity lymph nodes and retrosternal extension.

Question 27

What laboratory test is done for goiter?

Answer 27

Thyroid function tests (Free T3 T4 and TSH) which are usually normal.

Question 28

Why is indirect laryngoscopy done before thyroid surgery?

Answer 28

To assess vocal cord mobility (medicolegal requirement).

Question 29

What are the complications of simple nodular goiter?

Answer 29

Severe pressure symptoms tracheomalacia toxic change malignant transformation retrosternal extension and cystic changes.

Question 30

What is tracheomalacia?

Answer 30

Necrosis of tracheal rings due to prolonged pressure from a large goiter.

Question 31

What is the most common complication of long-standing simple goiter?

Answer 31

Retrosternal goiter.

Question 32

What percentage of simple nodular goiters become toxic?

Answer 32

0.3

Question 33

What percentage of simple nodular goiters become malignant?

Answer 33

0.03

Question 34

How is simple diffuse goiter treated?

Answer 34

Reassurance correction of the cause and low-dose L-thyroxine to reduce TSH release.

Question 35

What is the treatment for simple nodular goiter?

Answer 35

Subtotal thyroidectomy lobectomy hemi-thyroidectomy or total thyroidectomy.

Question 36

Why is total thyroidectomy more common than subtotal thyroidectomy today?

Answer 36

It reduces recurrence and ensures complete removal of nodular disease.

Question 37

What is given after thyroidectomy?

Answer 37

Low-dose L-thyroxine for hormone replacement and to prevent recurrence.

Question 39

Q: What are the three hormones produced by the thyroid gland

Answer 39

Thyroxine (T4) Triiodothyronine (T3) and Calcitonin.

Question 40

Q: What is toxic goiter

Answer 40

Thyroid enlargement with hyperthyroidism symptoms.

Question 41

Q: What are the two types of toxic goiter

Answer 41

Primary toxic goiter (Graves’ disease) and Secondary toxic goiter (Plummer’s disease).

Question 42

Q: What causes primary toxic goiter (Graves’ disease)

Answer 42

Autoimmune Long-Acting Thyroid Stimulators (LATS) increase thyroid size vascularity and function leading to excess T3 and T4.

Question 43

Q: What causes secondary toxic goiter (Plummer’s disease)

Answer 43

A simple nodular goiter becomes hyperactive producing excess T3 and T4.

Question 44

Q: What are the key autoimmune effects in Graves’ disease

Answer 44

True exophthalmos (eye bulging) and pre-tibial myxedema (skin thickening on legs).

Question 45

Q: What is the main difference between primary and secondary toxic goiter

Answer 45

Primary has sudden onset true exophthalmos and more nervous symptoms while secondary has gradual onset false exophthalmos and stronger cardiovascular effects.

Question 46

Q: What are the cardiovascular symptoms of toxic goiter

Answer 46

Palpitations tachycardia high-volume pulse arrhythmias and heart failure in severe cases.

Question 47

Q: What are the neurological symptoms of toxic goiter

Answer 47

Insomnia irritability tremors sweating hyperactivity and muscle weakness.

Question 48

Q: What are the metabolic symptoms of toxic goiter

Answer 48

Weight loss despite increased appetite hot intolerance and increased basal metabolic rate.

Question 49

Q: What are the gastrointestinal symptoms of toxic goiter

Answer 49

Increased appetite and diarrhea.

Question 50

Q: What are the key eye signs in Graves’ disease

Answer 50

Exophthalmos Von Graefe’s sign (lid lag) Stellwag’s sign (infrequent blinking) and Möbius sign (weak eye convergence).

Question 51

Q: What happens to thyroid hormone levels in toxic goiter

Answer 51

T3 and T4 increase while TSH decreases to near zero.

Question 52

Q: What does a thyroid ultrasound show in toxic goiter

Answer 52

Increased gland size smooth or nodular surface and hypervascularity.

Question 53

Q: What does a thyroid scan show in toxic goiter

Answer 53

Diffuse increased uptake in primary goiter and a hot nodule in toxic nodular goiter.

Question 54

Q: What are the treatment options for toxic goiter

Answer 54

Medical treatment antithyroid drugs beta-blockers radioactive iodine and surgery.

Question 55

Q: What are the indications for medical treatment

Answer 55

Primary thyrotoxicosis recurrent cases refusal or contraindication for surgery and preoperative preparation.

Question 56

Q: What are the two main antithyroid drugs

Answer 56

Carbimazole and Propylthiouracil (PTU).

Question 57

Q: How does radioactive iodine treat toxic goiter

Answer 57

It destroys thyroid follicles by emitting radiation inside the gland.

Question 58

Q: When is surgery recommended for toxic goiter

Answer 58

Failure of medical treatment toxic nodular goiter solitary toxic nodule or retrosternal goiter.

Question 59

Q: What are the complications of thyroid surgery

Answer 59

Accidental removal of parathyroid glands causing tetany and nerve injury affecting the recurrent or external laryngeal nerve.