Dr. Ertan Beyatlı

Goiter - Symptoms and causes

(Update: ) - general subjects

Goiter (Goiter) is an enlargement of the thyroid gland. The normal troit gland has a weight of 20-25 gm and dimensions of 20 x 25 x 50 mm.

Not every palpable thyroid gland can be considered as a goiter, but a definitive diagnosis should be made by ultrasonographic measurement. If the depth diameter of the thyroid gland is over 25mm in ultrasonography, a goiter diagnosis can be made.

Goiter Types

There are various classifications of goiter. It is divided into 3 main classes according to the hormone production status of the thyroid gland:

  • Euthyroidism: normal levels of hormones
  • Hypothyroidism: hormones decreased
  • Hyperthyroidism: hormones are elevated

What is a thyroid nodule?

It is a mass in the thyroid gland. Nodules are cystic, solid and mixed. Only liquid in the cystic nodule, Solid nodules are the growth and proliferation of cells, and Mix nodules are nodules with cystic and solid parts. (see, Thyroid Nodules)

What are the symptoms of goiter?

  1. Hypothyroidism (Less work of the thyroid gland); fatigue, weakness, lethargy, drowsiness, lack of concentration, dizziness, depression, hair loss, dry and cold feeling on the skin, constipation, weight gain, swelling of the eyelids and legs, reduced sweating, wax-like skin, cold intolerance, chills, hoarseness, hoarseness, worsening in speech, decreased reflexes, low blood pressure, high cholesterol and pulse, menstrual irregularity, difficulty in conceiving, children It manifests itself with symptoms such as short stature and growth retardation.
  2. Hyperthyroidism (Too much work of the thyroid gland); irritability, excessive excitement, sensuality, weight loss, sweating and increased body temperature, shaking hands, increased pulse rate and blood pressure, skin sweating and feeling moist, hair loss, heat intolerance, increased bowel movements, menstrual irregularity, vivid gaze, sometimes odd eye enlargement, sometimes manifests as double vision.

How is goiter diagnosed?

Goiter diagnosis; examination, blood test (T3, T4, TSH hormones examination), thyroid ultrasound or thyroid scintigraphy.

thyroid scleraphy
thyroid scleraphy

What are the treatment methods for goiter?

Treatment methods; drug therapy, radioactive iodine therapy and surgical treatment. Which or which of the treatment methods will be chosen varies from patient to patient. The most appropriate treatment method should be planned and followed by a team consisting of surgeons, endocrinologists, radiologists and pathologists.

Types of Thyroidectomy

  • Hemithyroidectomy
  • Subtotal thyroidectomy
  • Partial thyroidectomy
  • Near total thyroidectomy
  • Total thyroidectomy
  • Hartley Dunhill operation

Types of Thyroid Surgery

There are three main thyroid surgeries:

  • Thyroid lobectomy (Thyroid lobectomy)
  • Total or near-total thyroidectomy (Total or Near-total thyroidectomy)
  • Thyroidectomy Completion, Complementary Thyroidectomy (Completion thyroidectomy)

Thyroid lobectomy

This surgery involves removing half of the thyroid gland that is the nodule. It is sometimes referred to as "diagnostic lobectomy" because the preoperative diagnosis can be uncertain and part of the cause of the surgery is to diagnose cancer. In these patients, the result of needle (TIIAB, FNA) biopsy is non-diagnostic, suspicious for malignancy or showing a follicular or Hurthle cell neoplasm.

Diagnostic lobectomy may or may not include a frozen section (Forezn). A frozen section is the biopsy of the nodule taken during the operation while the patient is still under anesthesia. The pathologist examines one or two slices of the thyroid nodule under a microscope and tries to make a diagnosis. If definite cancer is found in the frozen part, then the patient's total thyroidectomy surgery is decided. It is important to note that the frozen section is not 100% correct. Because the pathologist looks at only one or two slices of the nodule, it is likely to be evidence of cancer, not on the slices examined. More often than not, the pathologist cannot diagnose follicular or Hurthle cell cancer on the frozen section, and the final pathology (permanent sections that require special handling and allows examination of the entire sample) must be awaited. The final pathology is usually ready about 5-7 business days after surgery. If cancer is not found in the frozen part but is found in the final pathology, a second surgery may be required to remove the rest of the thyroid gland (completion thyroidectomy or thyroidectomy completion). Ultimately, whether or not a frozen section is shipped will depend on the surgeon's experience and expertise.

All patients with half of the thyroid gland removed will need to have their thyroid levels checked sometime after surgery. Due to these levels, some patients may need thyroid hormone replacement, and some patients do not.

Total or near-total thyroidectomy

This surgery involves removing the entire or almost all of the thyroid gland. Large goiter or Graves' disease can be done for benign thyroid conditions that affect the thyroid lobes, or it can be done for cancer. Near-total thyroidectomy means the surgeon has decided to leave a very small amount of benign thyroid tissue behind. Thyroid tissue may be deliberately left behind in areas around important structures such as nerves or parathyroid glands that control voice, such as swallowing and breathing. All patients undergoing a total or near-total thyroidectomy should be on postoperative lifelong thyroid hormone replacement.

Thyroidectomy Completion (Complementary thyroidectomy)

Completion thyroidectomy involves removing the remaining thyroid tissue after a patient has previously undergone partial thyroid resection (i.e. lobectomy). It can be done years later or done shortly after lobectomy (as early as the next week). The reasons for completing thyroidectomy are the same as for lobectomy or total thyroidectomy. . All patients who underwent completion thyroidectomy should be on postoperative life-long thyroid hormone replacement.

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