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ABSTRACT

Iodine defciency is one o the known causes o nodular goiter

worldwide; sizes and weights are also dependent on dietary intake o iodine.

Multinodular nontoxic goiters are usually asymptomatic in some but with

observable growth o the thyroid. Prompt consultation and treatment areimportant to prevent urther complicitons. urrent diagnostics are reliable

and cost e!ective mostly or benign goiters. "reatment is dependent on the

progression o the disease and health status o the patients; surgeons may

opt or near#total or total thyroidectomy. Multinodular nontoxic goiters can

also be treated with new noninvasive technologies that may be used as

ad$unct to previous therapies.

OBJECTIVES:

%. "o present the case o &.'.; a case o multinodular nontoxic goiter(. "o brie)y discuss the anatomy* physiology+pathophysiology*

management o multinodular nontoxic goiter.

INTRODUCTION:

In iodine defcient areas such as some Italian regions* nodular goiter is

present in (,#-- o the population* its re/uency increasing with age.

In iodine su0cient areas the prevalence o nodular goiter is comprised

between 1.2 and 3.( high in iodine defcient areas and about 2 in

iodine su0cient countries In the 4nited 5tates* 6,1 or thyroid nodules. In the 7ramingham

study* ultrasonography revealed that - o men older than 81 years

had thyroid nodules* while -8 o women aged 29#,: years hadthyroid nodules.

"he emale#to#male ratio is 2%.

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Ene month prior to admission* the patient observed an let anterior

neck mass measuring -x- cms; movable* nonpulsating* sot* with nodular

surace* no tenderness noted* no ever was noted* no associated di0culty o

breathing. "he patient then sought consult at the A%M EP' 5urgical

department and was diagnosed with multinodular nontoxic goiter. "hyroid

ultrasound revealed "hyromegaly with complex cystic mass with muralnodule suggesting colloid cyst* let associated with co#existing heterogenous

small solid nodule exhibiting borderline eatures; normal sized right thyroid

gland with n looking thyroid cysts. "he patient was then scheduled or

elective surgery and thus* was admitted.

PB5" M?'IB& DI5"EAF no past medical or surgical histories

7BMI&F DI5"EAF

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2thhospital day (ndpost op day the patient had no other sub$ective

symptoms except or

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# linical maniestations+eatures@ontoxic multinodular goiters oten present with enlargement othe thyroid at the neck area."oxic multinodular goiters are usually in older patients and those

who had prior history o a nontoxic multinodular goiter

# 'iagnosticsAadionuclide imaging uses Iodine#%(- and Iodine#%-%. "heseisotopes are used to screen and treat patients with di!erentiatedthyroid cancers or metastatic disease. "he images provideinormation about the size* shape o the gland* and thedistribution o unctional activity.4ltrasound no radiation exposure. Delpul in the evaluation othyroid nodules* distinguishing solid rom cystic* size andmulticentricity. It is also helpul or assessing lymphadenopathies

and to guide 7@BC."+MAI scan helpul or evaluating the extent o large* fxed orsubsternal goiters

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E@&45IE@"he clinical maniestations o each disease di!er rom one patient to

another. "his is also true or patients with multinodular nontoxic goiter.

Patients may present initially with thyroid growth* while others would bedysphagia or hoarseness o voice. ?ssential to the diagnosis o would entailthorough history and physical examination that will be supported bydiagnostics like ultrasound* ct+mri scans* radioactive iodine uptake. "hus*rapport with patients is important* as well as application o knowledge andskills o physicians in controlling possible thyroidectomy complications andthe use o their so#calledclinical eye to accurately diagnose anddi!erentiate toxic rom non toxic multinodular goiters. 7urther studies* shouldbe done to support the use o new technologies to supplement in thetreatment o patients.

CIC&IE>ABPDFCook source 5chwartzs Principles o 5urgery %1thedition.

Internet sourceshttp++www.ncbi.nlm.nih.gov+pubmed+91%99:(http++emedicine.medscape.com+article+%(11-2#overviewNa8http++endocrinediseases.org+thyroid+goiter.shtml

http++m.e$e#online.org+content+%3(+(+A23.short

Dans >ra. 7ebruary (1%,."D?ABPF E7 ?@'EAI@? 'I5?B5?

Aecombinant human "5D and radioactive iodine therapy in the management

o benign multinodular goiter. ?uropean Oournal o ?ndocrinology.

http++www.a$nr.org+content+early+(1%,+1-+(8+a$nr.B2(38.abstract

he F* et al. March (1%,. "reatment o Cenign "hyroid @odules

omparison o 5urgery with Aadiore/uency Bblation. Bmrican 5ociety o

@euroradiology.

http://www.ncbi.nlm.nih.gov/pubmed/9019982http://emedicine.medscape.com/article/120034-overview#a6http://endocrinediseases.org/thyroid/goiter.shtmlhttp://m.eje-online.org/content/172/2/R47.shorthttp://www.ncbi.nlm.nih.gov/pubmed/9019982http://emedicine.medscape.com/article/120034-overview#a6http://endocrinediseases.org/thyroid/goiter.shtmlhttp://m.eje-online.org/content/172/2/R47.short