Goitre

Question 1

Causes of Goitre

Answer 1

A) Euthyroid

1. Physiological goitre at puberty
2. Compensated hypothyroid - Endemic- iodine deficiency goitre; Dyshormonogenesis
3. Hashimoto’s thyroiditis

B) Thyrotoxicosis

1. Grave’s disease
2. Hashimoto’s thyroiditis

C) Hypothyroid

1. Endemic goitre
2. Goitrogens in food or drugs
3. Dyshormonogenesis
4. Hashimoto’s thyroiditis

Question 2

Steps in physical examination of Goitre

Answer 2

A. Local examination of neck swelling -

1. Demonstrate it is a Goitre: moves with swallowing, not move with tongue protrusion
2. Note if the goitre causes pressure effect: Stridor, dysphagia, tracheal deviation
3. Palpate for size, shape, consistency, tenderness, thrill, retrosternal extension, carotid pulse and cervical lymph nodes
4. Listen for bruits (sign of toxic goitre)

B. Look for sign suggesting hyper/ Hypothyroidism
(Mentality> face > hand & skin > CNS)
1. Talk to child to assess his mentality/ hearing
2. Note child’s facial appearance ? coarse
3. Note one’s height and measure body proportions
4. Skin and hair texture and temperature
5. Eye examination
6. Hand examination (temp, pulse, sweating, clubbing, tremor and pulse rate)
7. LL examination for jerk and pretibial oedema
8. Abdomen for umbilical hernia
9. Look for cerebellar sign if indicated
(Acropachy due to soft tissue swelling and subperiosteal reaction)

Question 3

Thyrotoxicosis

Answer 3

Tall
Normal mentality, Anxious
Eye- Exophthalmos, lid retraction/ lag, ophthalmoplegia
Skin- warm and sweaty
Hands- Tremor, Tachycardia, bounding pulse

Question 4

Hypothyroidism

Answer 4

Short, infantile proportion
Mentally slow
Body weight > expected
Skin - dry, coarse, cold
Hair - dry, sparse and coarse
Bradycardia
Umbilical hernia
Slow relaxation of Jerks
Ataxia
Speech and hearing loss in Pendred syndrome