Please enable JavaScript.

Coggle requires JavaScript to display documents.

Goitre - Coggle Diagram

- - - - Iodized tablet salt in endemic areas
    - - No ttt
        
        Reassurence
        
        Regular follow up
      - If pressure symp. >>> L-thyroxine 0.1-0.2mg/day
    - - thyroidectomy if
        
        compression symptoms
        
        Cosmotic disfigurment
        
        Postop. replacement of L- thyroxine
- - - - Diffuse (1ry) or nodules (2ry) goitre
  - - - True exophthalmos
        
        Autoimmune manifestation
        
        Die to retrobulber cells and fliud infeltration
        
        Papilleoedema, corneal ulceration and optic nerve neuropathy in severe cases
        
        Lateral tarsorrhaphy help to protect eye
        
        Improvement with high dose of systemic prednisolone
        
        Clinical detection of exophthalmos
        
        Nafziger's method
        
        Russel Frazer's method
        
        Ruler test
      - False exophthalmos
        
        Due to upper eyelids retraction
        
        In both diffuse and nodular toxic goiter
        
        Disappears when hyperthyroidism is treated
      - Eye signs
        
        Moderate
        
        Dalrymple's sign
        
        Joffroy's sign
        
        Severe
        
        Moebius's sign
        
        Mild
        
        Stellwell's sign
        
        Von Graefe's sign
    - - Diffuse
        
        Diffusely enlarged gland
  - - - Aim
        
        Euthyroid then maintenance dose
      - Medications
        
        Antithyroid drugs
        
        Carbimazole
        
        Duration
        
        Mantainence
        
        Dose
        
        Side effects
        
        Action
        
        Propylthiouracil (Pregnant & lactating)
        
        Action
        
        B blocker
        
        Chemical jacket of the heart
        
        Action
        
        Contraindication
        
        Iodides
        
        Action
        Wolf- chaik off effect
        
        Duration
        
        Indication
      - Indications (5)
      - Advantages
        (avoid surgery & radioactive iodine SE)
      - Drawbacks (4)
    - - Mexhanism of action
        
        Destroys thyroid cells >>> decrease functioning thyroid tissue
      - Dose
      - Possible side effects
        (not proven)
        
        Leukemia
        
        Thyroid carcinoma
        
        Genitic damage
      - Indications (5)
      - Advantages
        
        Avoidance of surgery and prolonged medical ttt
      - Disadvantages
        
        Thyroid insufficiency in 75-80%
    - - Preparation
      - Advantages (2)
      - Indications (6)
      - Drawbacks (3)
  - - - On top of long standing simple modular goiter
      - Affected middle aged and elderly persons
      - Hyperactive internodular tissue
      - Insidious onset with more cardiovascular manifestations
    - - due to Thyroid stimulating Abs
      - Whole gland enlargment
      - Proliferation of acini epithelial lining
      - Columnar cells. full of granules
      - Marked vascularity increase
      - Extensive lymphocytic infiltration
      - Nervous, metabolic and eye manifestations
      - Affect mainly young females
      - Charactarized bu remession and exxacerbations
    - - Solitary, hyperactive and autonomous
      - Cause TSH secretion suppression with subsequent suppression of the remainder of thyroid