DIFFUSE AND MULTINODULAR GOITER (Basic Pathology)

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DIFFUSE AND MULTINODULAR GOITER

|--- Introduction
| |--- Enlargement of the thyroid, most common manifestation of thyroid disease
| |--- Diffuse and multinodular goiters reflect impaired synthesis of thyroid hormone
| |--- Impaired synthesis leads to compensatory rise in serum TSH
| |--- Causes hypertrophy and hyperplasia of thyroid follicular cells
| |--- Gross enlargement of the thyroid gland
| |--- Degree of enlargement proportional to level and duration of hormone deficiency
|
|--- Types of Goiters
| |--- Endemic Goiter
| | |--- Occurs in geographic areas with low iodine content in soil, water, and food
| | |--- Present in more than 10% of the population in a given region
| | |--- Common in mountainous areas (Himalayas, Andes)
| | |--- Declined significantly with dietary iodine supplementation
| |--- Sporadic Goiter
| | |--- Less common than endemic goiter
| | |--- More common in females, peak incidence in puberty or young adulthood
| | |--- Causes:
| | | |--- Substances interfering with thyroid hormone synthesis (e.g., excessive calcium,
certain vegetables)
| | | |--- Hereditary enzymatic defects (dyshormonogenetic goiter)
| | | |--- Often unknown cause
|
|--- Morphology
| |--- Diffuse Goiter
| | |--- TSH-induced hypertrophy and hyperplasia of thyroid follicular cells
| | |--- Initial diffuse, symmetric enlargement of the gland
| | |--- Follicles lined by crowded columnar cells
| | |--- May form projections similar to Graves disease
| |--- Colloid Goiter
| | |--- If dietary iodine increases or hormone demands decrease
| | |--- Stimulated follicular epithelium involution to form an enlarged, colloid-rich gland
| | |--- Cut surface: brown, glassy-appearing, and translucent
| | |--- Follicular epithelium may be hyperplastic or flattened and cuboidal
| | |--- Colloid abundant during involution periods
| |--- Multinodular Goiter
| | |--- Recurrent episodes of hyperplasia and involution
| | |--- Irregular enlargement of the thyroid
| | |--- Conversion of long-standing diffuse goiters into multinodular goiters
| | |--- Multilobulate, asymmetrically enlarged glands
| | |--- Irregular nodules with variable amounts of brown, gelatinous colloid
| | |--- Older lesions show fibrosis, hemorrhage, calcification, and cystic change
| | |--- Microscopic appearance: colloid-rich follicles and areas of hypertrophy and
hyperplasia
|
|--- Clinical Features
| |--- Mass effects of enlarged gland
| | |--- Cosmetic problem of a large neck mass
| | |--- Airway obstruction
| | |--- Dysphagia
| | |--- Compression of large vessels (superior vena cava syndrome)
| |--- Hyperfunctioning (toxic) nodule may develop

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