• 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.

Definitions
At apnea: is the cessation of breathing greater than 10 seconds.
In obstructive apnea: is a cessation of breathing by pharyngeal obstruction related to hypotonia of pharyngeal muscles with persistence of respiratory movements.
A central apnea: is the cessation of respiratory drive with stop motion and respiratory flow.
A hypopnea: it decreased ventilation of about 50%.
A syndrome of sleep apnea: it is from 10 apneas + hypopneas per hour of sleep.
A syndrome of severe sleep apnea: is when the apnea-hypopnea index greater than 30%.

Epidemiology
9 Apnea Syndrome Sleep button:
4 3 to 5% of the male population,
4 1 to 2% of the female population.
9 Risk factor: hypertension, stroke, myocardial infarction, car accidents, social gene.

Screening

• Polygraphie respiratory recording of nocturnal SaO 2, respiratory movements, respiratory flow, snoring.
• Polysomnography: respiratory polygraphy + + EEG + EMG electro-occulogramme.

Pathophysiology
Snoring: is the vibration of the posterior wall of pharynx narrowed.
Obstructive:
pharyngeal closure during inspiration in sleep (Promotes alcohol, sedatives, …)
respiratory movements persist when there is a struggle of O 2 desaturation, and bradycardia microréveil, taken with noisy inspiratory tachycardia.

Clinical signs

• Often a man over 45 years, generally obese
• Snoring loud sometimes prolonged apnea,
• restless sleep, wake-up call Apnea
• Asthenia morning, daytime sleepiness (watching TV, driving, reading a newspaper, …), morning headaches, impaired concentration, impotence, urinary frequency at night.
• Anomaly anatomical reduction of the soft palate, large uvula, chin back, enlarged tongue, tonsils, deviated nasal septum.

Balance Sheet
nocturnal SaO 2: desaturation “comb”
Polysomnography:
apnea, SaO 2 mean, minimum desaturation snoring, sleep stage IV + REM sleep, microreveils,
superficial sleep, stage I and II, little sleep III and IV and some REM sleep.
Polygraph,
Cephalometry
pulmonary function tests + blood gases: Research pulmonary chronic obstructive associated hypercapnia.

Treatment
A Medical: diet, no alcohol at night, not sleeping pills, light dinner.
A Mechanics:
Pressure continues positive night life, keeps the airways open.
effective pressure from 6 to 14 cm H 2 O
pressure fixed or variable, humidifier.
Education equipment (nasal breathing, prevent leaks, although the address mask, protection of the nasal bridge)
dramatic effect with disappearance of drowsiness,
side effects or unwanted noise, rhinitis, conjunctivitis, …
A Surgical:
uvulo-palato-pharyngoplastie,
tonsillectomy,
vegetation
advancement of the mandible.
A oral prosthesis,
Sometimes adding O 2 on the mask.