1 – goiters:
Definition:
Diffuse increase in the volume of the thyroid gland that is not cancer or thyroiditis, which is not accompanied by disturbance of thyroid function.
Mechanisms:

  • Inability of the thyroid gland to provide the amount of hormone needed to require the agency at some point.
  • The decrease in hormone levels will lead to hyper-secretion of TSH, which will cause an enlargement of the gland.

Causes:

  • Iodine deficiency
  • Partial deficiency in thyroid hormones
  • Using drugs that block the conversion of iodine (eg lithium) or certain foods (cabbage, rape)

Epidemiology:

  • More common in women
  • Depending on their frequency in a given population, it is called endemic goiter and sporadic.
  • Endemic goiters occur in certain regions of the world generally have a deficiency in iodine (eg mountainous regions)




Clinic:

  • No functional sign
  • No metabolic disorder
  • Increase the volume of the neck with or without cervical lymphadenopathy (often a sign of malignancy)
  • Sometimes dysphonia, dysphagia, dyspnea, collateral circulation in case of local compression.

Investigations:

  • Normal hormonal assays
  • The measurement of serum calcitonin plasma eliminates the possibility of medullary carcinoma of the thyroid developed at the expense of cells C.
  • A ultrasound: diffuse goiter, homogeneous volume variable that will determine the need for treatment

Treatment:

  • No treatment for simple goiter
  • If it is large, scalable, there are prescription hormone by levothyroxine, but this treatment should be followed for life.
  • If goitre is important surgery.

Evolution:

  • Possible exacerbations (at puberty, menopause, pregnancy),
  • Over the years, it becomes multi-nodular.
  • Possibility of development of carcinoma in goiter

Complications:

  • Hyperthyroidism
  • Signs of compression of the trachea, respiratory
  • Development of cancer with increasing volume of goiter, change its texture (decrease mobility, signs of cuts or cervical lymphadenopathy).


2 – Nodules:
Definition:

  • Abnormal production that gives the sensation of touch u hard body more or less rounded and well circumscribed.
  • They are routinely discovered by the patient or his environment or during a medical examination.
  • They are nodules that increases with swallowing, they are of thyroid origin.
  • Epidemiology:
    In 20% cases were thyroid adenoma
    In 10% cases, there is the notion of malignancy

Clinic:

  • Hard consistence, Cyst or Cancer
  • Soft consistency: benign
  • Sometimes dysphonia

Examinations:

  • Ultrasound detects nodules fluid (cysts)
  • The scan class nodules in 3 varieties:
    • hot: fix iodine more intense, benign
    • Isofix: fix the radio-active iodine
    • hypofixation (cold): absence of iodine uptake
  • The ENT examination visualizes the vocal cords for a differential diagnosis
  • Aspiration cytology

Treatment:

  • Different as appropriate
  • If it is a cold nodule, surgery to avoid missing a cancer.
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