• 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.