ROJoson PEP Talk: GOITER AWARENESS

1. Empowerment
objective - for
laypeople to have a
basic understanding
of THYROID GOITER
in their health
management.
GOITER
AWARENESS
January 21, 2023
1400H - 1500H
Via Zoom

2. Empowerment
objective - for
laypeople to have a
basic understanding
of THYROID GOITER
in their health
management.
GOITER
AWARENESS
ROJoson PEP Talk
I have a Patient
Empowerment
Program in which I
like to empower the
lay people or
patients to take
control in the
management of
their health.

3. I started the PEP Talk
on May 15, 2021.
There are 3 courses in
the PEP Talk.
I completed the Core
Course on October 9,
2021.

4. From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.

5. Empowerment
objective - for
laypeople to have a
basic understanding
of THYROID GOITER
in their health
management.
GOITER
AWARENESS
My PEP TALK today is
entitled:
GOITER
AWARENESS
This is my
contribution to
the PH DOH
Goiter Awareness
Week (4th week of
January).

6. Contents
• What is a goiter?
• What are the different types of goiter?
• What are the causes of goiter?
• How to recognize goiter and its different
types?
• What paraclinical diagnostic tests are usually
done for goiter?
• What are the usual treatment for the different
types of goiter?
• What are the post-treatment management for
goiter?
GOITER
AWARENESS

7. GOITER
AWARENESS
What is a goiter?

8. GOITER
AWARENESS
What is a goiter?
Loosely speaking, goiter refers to
something wrong with the thyroid gland, a
butterfly-shaped organ located in the base
and central part of the neck.
Goiter is defined as any disorder in the
thyroid gland.

9. GOITER
AWARENESS
What is a goiter?
The thyroid gland is a vital organ (vital organ –
one that is needed to survive) that regulates
metabolism, growth and development of the
human body. The thyroid gland makes, releases,
and controls thyroid hormones that control
metabolism. Metabolism is a process where the
food taken into body is transformed into energy.
This energy is used throughout the entire body to
keep many of the body's systems working
correctly.

10. GOITER
AWARENESS
What is a goiter?
Goiter is defined as any disorder in the
thyroid gland.

11. GOITER
AWARENESS
What are the different types of goiter?

12. GOITER
AWARENESS
What are the different types of goiter?
Goiter can be classified into several categories:
 By clinical presentation (diffuse or nodular
goiter; euthyroidism, hyperthyroidism,
hypothyroidism)
 By general categories of diseases (malignant vs
non-malignant disorders; hyperthyroidism vs
hypothyroidism)
 By names of specific disease

13. GOITER
AWARENESS
What are the different types of goiter?
Clinical Classification of Goiter:
• Diffuse toxic goiter (with diffuse enlargement
with hyperthyroidism)
• Diffuse non-toxic goiter (with diffuse
enlargement without hyperthyroidism – may
be euthyroidism or hypothyroidism)
• Nodular toxic goiter (with nodule/s with
hyperthyroidism)
• Nodular non-toxic goiter (with nodule/s
without hyperthyroidism may be euthyroidism
or hypothyroidism)

14. GOITER
AWARENESS
What are the different types of goiter?
Definition of diffuse enlargement – the major
lobes of the thyroid glands such as the right and
left lobes are almost symmetrically enlarged or
increase in size and without nodule/s

15. GOITER
AWARENESS
What are the different types of goiter?
Definition of nodules – presence of nodule /
nodules or lump/lumps / dominant mass/es

16. GOITER
AWARENESS
What are the different types of goiter?
Diffuse Goiter vs Nodular Goiter

17. GOITER
AWARENESS
What are the different types of goiter?
Diffuse enlargement – Hyperthyroidism, hypothyroidism or
euthyroidism (depending on the associated symptoms and
signs)
Nodule formation – Malignant vs non-malignant disorders

18. GOITER
AWARENESS
What are the different types of goiter?
Common diseases that I usually diagnose which
can be recognized clinically and relatively
common in the community:
• Hyperthyroidism (Graves’ Disease)
• Hyperthyroidism (unspecified)
• Hypothyroidism
• Acute thyroiditis
• Chronic thyroiditis

19. GOITER
AWARENESS
What are the different types of goiter?
Common diseases that I usually diagnose which
can be recognized clinically and relatively
common in the community:
Malignant nodules or thyroid cancers:
• Papillary carcinoma
• Follicular carcinoma
• Anaplastic carcinoma
• Medullary carcinoma

20. GOITER
AWARENESS
What are the different types of goiter?
Common diseases that I usually diagnose which
can be recognized clinically and relatively
common in the community:
Non-malignant nodules or conditions:
• Colloid cyst
• Colloid adenomatous nodule
• Multiple colloid adenomatous goiter
• *Diffuse colloid adenomatous goiter

21. GOITER
AWARENESS
What are the causes of goiter?

22. GOITER
AWARENESS
What are the causes of goiter?
In general, risk factors include:
• Genetic predisposition
• Environmental influence – like lack of
iodine intake; excessive exposure to
radiation to the neck; stress
NOTE: A lot of goiters have NO definite
known cause.

23. GOITER
AWARENESS
What are the causes of goiter?
More specific causes for specific diseases:
• Iodine deficiency goiter – lack of iodine intake
• Colloid adenomatous goiter – physiologic and
degenerative condition
• Cancer – genetic mutation with genetic
predisposition and radiation exposure
• Chronic thyroiditis – autoimmune disease
• Acute thyroiditis – infection
• Hyperthyroidism – autoimmune disease
• Hypothyroidism – iodine deficiency, physiologic

24. GOITER
AWARENESS
What are the causes of goiter?
Except for iodine deficiency goiter due to lack of
iodine intake which can be prevented, for the
other diseases, one, nobody can predict when
one is going to have a thyroid disease and two,
the causes are realistically difficult to identify and
to control.
Healthy lifestyle with adequate iodine intake is
the best bet against thyroid diseases. However,
there is a percentage that one cannot prevent a
thyroid disease from occurring even with a
healthy lifestyle.

25. GOITER
AWARENESS
How to recognize goiter and its different
types?

26. GOITER
AWARENESS
How to recognize goiter and its different
types?
• Lump/s on the front, base and central
part of the neck which moves up and
down with swallowing
• Lump/s on the side of the neck
• Palpitation
• Sudden weight loss
• Persistent fatigue

27. GOITER
AWARENESS
How to recognize goiter and its different
types?
Persistent fatigue
A cue or alert-signal for
HYPOTHYROIDISM

28. GOITER
AWARENESS
How to recognize goiter and its different
types?
• Palpitation
• Sudden weight loss
Cues or alert-signals for
HYPERTHYROIDISM

29. GOITER
AWARENESS
How to recognize goiter and its different
types?
• Lump/s on the front, base and central
part of the neck which moves up and
down with swallowing
• Lump/s on the side of the neck
Cues or alert-signals for tumors which
could be benign or malignant (need more
sign-cues)

30. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?

31. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Common instrumental and laboratory diagnostic
procedures that can be used after the clinical
diagnosis of goiter:
• Thyroid function tests – FT3, FT4, TSH
• Imaging procedures – ultrasound, thyroid scan,
CT Scan, MRI, PET Scan
• Needle aspiration ± biopsy

32. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Thyroid function tests – FT3, FT4, TSH
to check level of thyroid hormones in the blood –
euthyroid; hyperthyroid; hypothyroid.
Indications:
• when not sure whether a patient has
hyperthyroid or hypothyroid
• when needed to have a baseline and follow-up
values to monitor subsequent medical
treatment

33. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Thyroid function tests
Interpretations:
• Normal FT4 and normal TSH – euthyroidism
• Elevated FT4 and below normal TSH –
hyperthyroidism
• Below normal FT4 and elevated TSH -
hypothyroidism

34. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Imaging procedures – ultrasound, thyroid scan, CT
Scan, MRI, PET Scan
Indication:
When needed to evaluate the structure
(ultrasound, CT Scan, MRI) and at times, function
of the thyroid gland (thyroid scan and PET Scan)
Choose the most cost-effective ones.

35. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Imaging procedures – ultrasound, thyroid scan, CT
Scan, MRI, PET Scan
Indication:
Ultrasound, CT scan, MRI can be used to evaluate
the structure - size of the thyroid gland and
whether a nodule present is benign or malignant.
Choose the most cost-effective ones.

36. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Imaging procedures – ultrasound, thyroid scan, CT
Scan, MRI, PET Scan
Indication:
Thyroid scan using a radioactive isotope is used
primarily to determine whether there is nodule
that is hyperfunctioning or not.
Choose the most cost-effective ones.

37. GOITER
AWARENESS
What paraclinical diagnostic tests are
usually done for goiter?
Needle aspiration ± biopsy
Indications:
• When needed to determine whether a nodule
is solid or cystic (if cystic, needle aspiration
may be therapeutic in outcome)
• When needed to get a sample of solid nodule
for biopsy (whether benign or malignant - at
times the specific disease can be revealed)

38. GOITER
AWARENESS
What are the usual treatment for the
different types of goiter?

39. GOITER
AWARENESS
What are the usual treatment for the
different types of goiter?
• Watchful waiting
• Medications
• Operations
• RAI therapy
• Chemotherapy

40. GOITER
AWARENESS
Treatment for Non-Cancer Goiters
Goiters with functional disorders
• Hyperthyroidism
• Hypothyroidism
Goiters with non-functional disorders and benign
conditions
• Colloid adenomatous goiters
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!

41. GOITER
AWARENESS
Treatment for HYPOTHYROIDISM Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
Medical therapy (NO OPERATION as this will
aggravate the hypothyroidism)
Replacement therapy – thyroid hormones, usually
levothyroxine – usually lifetime!

42. GOITER
AWARENESS
Treatment for HYPERTHYROIDISM Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
3 options for goiters that are small to moderate in
size:
• Medical therapy with anti-thyroid drugs
• Operative therapy
• Radioactive iodine therapy
For huge-size goiters, operative therapy is
recommended!

43. GOITER
AWARENESS
Treatment for COLLOID ADENOMATOUS
GOITERS
4 categories:
• Diffuse colloid adenomatous goiter
• Colloid cyst
• Solitary colloid adenomatous goiter or nodule
• Multiple colloid adenomatous goiter
Options:
• Monitor without
meds
• Meds (levothyroxine)
• Operation
• Operation is
recommended for
huge-size goiter.
• Small to moderate
ones, no operation
(monitor without
meds or with meds)

44. GOITER
AWARENESS
Treatment for Non-Cancer Goiters
Goiters with functional disorders
• Hyperthyroidism
• Hypothyroidism
Goiters with non-functional disorders and benign
conditions
• Colloid adenomatous goiters
Goals of treatment
Curative vs control
• Some don’t recur
after treatment!
• Some recur!
Only time will tell!
NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
SURVEILLANCE OR
MONITORING NEEDED – LIFE
TIME!

45. GOITER
AWARENESS
Treatment for Thyroid Cancers
4 common types of thyroid cancers
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma

46. GOITER
AWARENESS
Treatment for Thyroid Cancers
The usual goals of thyroid cancer treatment
include
• eradicating known tumors / cancers entirely,
preventing the recurrence or spread of the
primary cancer, and
• relieving symptoms if all reasonable curative
approaches have been exhausted.
Curative goal
Palliative goal

47. GOITER
AWARENESS
Treatment for Thyroid Cancers
4 common types of thyroid cancers
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma
For curative goal:
• Primary treatment modality: OPERATION
• May be followed by radioactive iodine
therapy
• May be followed by medical suppressive
therapy using levothyroxine
For palliative goal:
• Chemotherapy
• Radiation therapy

48. GOITER
AWARENESS
Treatment for Thyroid Cancers
4 common types of thyroid cancers
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma
OPERATIONS:
• Thyroidectomy (subtotal / total)
• Neck dissection (different kinds)

49. GOITER
AWARENESS
What are the post-treatment
management?

50. GOITER
AWARENESS
What are the post-treatment
management?
After treatment for any type of goiter,
• Non-cancer goiters
• Cancer goiters (particularly)
there must be surveillance or follow-up or check-
up – usually lifetime – for recurrence.
Early detection of recurrence  early treatment
 better outcome!

51. GOITER
AWARENESS
What are the post-treatment
management?
Patients may be taking maintenance meds for
control of disease – may be lifetime!
Patients are advised to have a healthy lifestyle to
promote health restoration and maintenance.
Except for ANAPLASTIC THYROID CA (fortunately
rare) and advanced cancers, the rest can still have
a long life after treatment.

52. Contents
• What is a goiter?
• What are the different types of goiter?
• What are the causes of goiter?
• How to recognize goiter and its different
types?
• What paraclinical diagnostic tests are usually
done for goiter?
• What are the usual treatment for the different
types of goiter?
• What are the post-treatment management for
goiter?
GOITER
AWARENESS
Summary
Take Away

53. GOITER
AWARENESS
Take Away in
relation to
Patient
Empowerment
Be always in touch with reliable medical
information on THYROID GOITER.
Knowledge is power; it gives power.
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of THYROID GOITER.

54. Empowerment
objective - for
laypeople to have a
basic understanding
of THYROID GOITER
in their health
management.
GOITER
AWARENESS
My PEP TALK today is
entitled:
GOITER
AWARENESS
This is my
contribution to
the PH DOH
Goiter Awareness
Week (3rd week of
January).