Simple Goiter

  1. General information
    1. Enlargement of the thyroid gland not caused by inflammation or neoplasm
    2. Types
      1. Endemic: caused by nutritional iodine deficiency, most common in the "goiter belt" (midwest, northwest, and Great Lakes regions), areas where soil and water are deficient in iodine; occurs most frequently during adolescence and pregnancy
      2. Sporadic: caused by
        1. ingestion of large amounts of goitrogenic foods (contain agents that decrease thyroxine production): e.g., cabbage, soybeans, rutabagas, peanuts, peaches, peas, strawberries, spinach, radishes
        2. use of goitrogenic drugs: propylthiouracil, large doses of iodine, phenylbutazone, para-amino salicylic acid, cobalt, lithium
        3. genetic defects that prevent synthesis of thyroid hormone
    3. Low levels of thyroid hormone stimulate increased secretion of TSH by pituitary; under TSH stimulation the thyroid increases in size to compensate and produces more thyroid hormone.
  2. Medical management
    1. Drug therapy
      1. Hormone replacement with levothyroxine (Synthroid) (T4), dessicated thyroid, or liothyronine (Cytomel) (T3)
      2. Small doses of iodine (Lugol's or potassium iodide solution) for goiter resulting from iodine deficiency
    2. Avoidance of goitrogenic foods or drugs in sporadic goiter
    3. Surgery: subtotal thyroidectomy (if goiter is large) to relieve pressure symptoms and for cosmetic reasons
  3. Assessment findings
    1. Dysphagia, enlarged thyroid, respiratory distress
    2. Diagnostic tests
      1. Serum T4 level low-normal or normal
      2. RAIU uptake normal or increased
  4. Nursing interventions
    1. Administer replacement therapy as ordered.
    2. Provide care for client with subtotal thyroidectomy (see Thyroidectomy) if indicated.
    3. Provide client teaching and discharge planning concerning
      1. Use of iodized salt in preventing and treating endemic goiter
      2. Thyroid hormone replacement


tradeshow booths said...

Thank you for this post on simple goiter. I just found out I may have a slightly enlarged thyroid, aka, simple goiter. You post was one of the first ones I found on google, and was just the information I was looking for. Thank you! :)