Presentation
ICD Code ICD Description Total National Projected Hospitalizations - Annualized (Present on Admission - All) Total Medicare Hospitalizations - Oct 2015 to Sep 2018 (Present on Admission - All) Total National Projected Hospitalizations - Annualized (Present [dexur.com]
We present a rare case of a giant substernal nontoxic goiter which caused acute respiratory failure which was treated by urgent thyroidectomy through a T-incision. [ncbi.nlm.nih.gov]
About 10% of these patients require emergency airway intubation (4), as in the present case. [scielo.br]
Entire Body System
- Goiter
Parent Code: E04 - Other nontoxic goiter [icd.codes]
Goiter Goiter due to thyroiditis Goiter, euthyroid Goiter, substernal Non-toxic nodular goiter Substernal goiter Thyroid goiter Thyroid goiter, adenomatous Thyroid goiter, nontoxic, nodular Thyroiditis unspecified, with goiter Clinical Information An [icd10data.com]
[…] substernal goiter Substernal goiter may obstruct thoracic inlet & compress trachea [specialty.mims.com]
- Chills
/ Via ernest baker @ernestbaker_ Drake album cover looks like wall art at the barbershop / Via Drake's album cover looks like a chill utopia where you learn to truly know your self. 02:39 AM - 22 Aug 2013 Cameron Reed @cameronreed Drake's album cover [buzzfeed.com]
Autoimmune thyroiditis (Hashimoto, chronic lymphocytic) Persistent immune system inflammation of person's own thyroid Goiter Hypothyroidism Subacute thyroiditis (painful, de Quervain) Viral infection Painful, tender and swollen gland Malaise, fever, chills [endocrinesurgery.ucsf.edu]
Tyler Timmons: Melodic, chill and just nice happy music—that makes you feel good. BlackFilm: Are you going to seek advice from Drake about making music since he is very popular on the charts? Tyler Timmons: I dunno. We’ll have to see how it goes. [blackfilm.com]
- Laboratory Technician
§ Laboratory technician, Radioactivity Research Center, University of California Medical Center. [nejm.org]
- Unconsciousness
Followed by Rafe and Nadine, Sam triggers a trap and sets off an explosion, resulting in a support beam breaking off, simultaneously pinning him and knocking him unconscious. [uncharted.fandom.com]
Respiratoric
- Pharyngitis
Eosophageal Motility (Peristaltic, Simultaneus, Failed, mean wave amplitude, mean wave duration, velocity) Pressure in the upper oesophageal sphincter: Upper oesophageal sphincter residual pressure (mmHg) Upper oesophageal relaxation duration (msec) Peak-pharyngeal [open.rsyd.dk]
Non-thyroid lumps and swellings Congenital and developmental swellings: Thyroglossal cyst Branchial cyst Pharyngeal pouch Dermoid cyst Laryngocele Lymph nodes - swelling due to inflammation, infection or malignancy. [patient.info]
[…] ul><ul><li>68% Bacterial (S. aureus, S. pyogenes) </li></ul></ul><ul><ul><li>15% Fungal </li></ul></ul><ul><ul><li>9% Mycobacterial </li></ul></ul><ul><li>May occur secondary to </li></ul><ul><ul><li>Pyriform sinus fistulae </li></ul></ul><ul><ul><li>Pharyngeal [slideshare.net]
Cardiovascular
- Palpitations
All the patients complained of some symptoms of hyperthyroidism (palpitation, hot intolerance, sweating, tiredness and tachycardia). [endocrine-abstracts.org]
The signs to look out for are: Overactivity Underactivity Mood change Sloth like Weight loss Weight gain Tremor Puffy face constipation Loose motions Depression Palpitations Cold intolerance Heat intolerance Hair loss Loss of libido Irregular periods [endocrinesurgeon.co.uk]
Common signs and symptoms of hyperthyroidism include heart palpitations, increased heart rate, intolerance to heat, nervousness, insomnia, breathlessness, increased bowel movements, light or absent menstrual periods, fatigue, trembling hands, weight loss [fortherecordmag.com]
These may include weakness and fatigue, palpitations and chest pain or pressure, and changes in memory and mood. Toxic nodular goiter does not cause the bulging eyes that can occur with Graves disease. [medlineplus.gov]
For hyperthyroidism, the most common symptoms are associated with adrenergic stimulation: tachycardia (increased heart rate), palpitations, nervousness, tremor, increased blood pressure and heat intolerance. [en.wikipedia.org]
Face, Head & Neck
- Neck Swelling
Symptomatic patient may present with painless neck swelling, cosmetic complaints, shortness of breath, sudden increase in goiter size with pain due to hemorrhage, larger goiter causing obstructive signs eg dysphagia, choking sensation and Pemberton's [specialty.mims.com]
Sometimes the patient seeks help for obvious neck swelling and cosmetic disfigurement of the neck. As MNG becomes palpable once the size is more than 1 centimeter, so large MNG mainly presents with neck swelling. [intechopen.com]
On physical examination, there will be a central neck swelling that could be smooth or nodular and the mass moves with swallowing. It may deviate the trachea or extend retrosternally. [statpearls.com]
Neurologic
- Confusion
It may produce a fever, extreme weakness, mood swings, confusion, altered consciousness, coma, and enlarged liver with jaundice. It may be life threatening if not treated emergently. [fortherecordmag.com]
– Tremor also occurs but can be confused with essential senile tremor.Tremor also occurs but can be confused with essential senile tremor. – Cardiovascular complications occur commonly in elderly patients, and aCardiovascular complications occur commonly [slideshare.net]
I’m confused by the way the zeitgeist is backtracking on Drake this time around. I’m not going to make excuses for the misogyny, but part of the appeal on Take Care was that Aubrey’s emotional honesty felt universal. [hazlitt.net]
Workup
Any cervical lymphadenopathy should suggest malignancy: a workup is warranted. Vocal cords must be examined in cases of hoarseness or before and surgical intervention. [statpearls.com]
Treatment
[…] of sporadic nontoxic goiter--some answers and more questions. ( 11238475 ) Samuels M.H. 2001 15 A randomized trial comparing levothyroxine with radioactive iodine in the treatment of sporadic nontoxic goiter. ( 11238476 ) Wesche M.F....Wiersinga W.M. [malacards.org]
However, both disease-specific and generic HRQoL deficits persisted six months after treatment. [ncbi.nlm.nih.gov]
Prognosis
Prognosis A non-toxic goiter is a benign entity and only causes aesthetic problems. However, if the size is large, it may compress the trachea, laryngeal nerves, and the esophagus. Most benign goiters have an excellent prognosis. [statpearls.com]
Support Groups: Expectations (prognosis): Since toxic nodular goiter is primarily a disease of the elderly, other chronic health problems may influence the outcome of this condition. [uclahealth.org]
[…] but may be seen incidentally CT may be useful for fully characterizing the extent of substernal (retrosternal) goiter an enlarged and heterogeneous thyroid gland suggests the diagnosis, which is confirmed by ultrasound or scintigraphy Treatment and prognosis [radiopaedia.org]
Precancerous lesions can be characterized by the presence of nodular goiter, which in inflammatory processes in the cervical region, as well as various types of radiation, can develop into cancer, thyroid cancer, the prognosis is poor because the tumor [tr-ex.me]
Etiology
Certain conditions have both an underlying etiology and multiple body system manifestations due to the underlying etiology. [icd10coded.com]
Treatment depends on the underlying etiology and includes, e.g., surgery (thyroidectomy) for malignant and autonomous nodules, fine needle aspiration for thyroid cysts, and observation for small, benign nodules. [amboss.com]
Goitrous enlargement may result from various etiologies: stimulation from elevated TSH levels as seen in iodine deficiency and Hashimoto disease, TSH-receptor antibodies/agonists as in Graves disease, or unclear etiology such as in nontoxic multinodular [ime.acponline.org]
Etiology is usually unknown. Some known causes include iodine deficiency, iodine excess, goitrogen ingestion, autoimmune disorders, thyroid hormone production defects and certain medications. It is usually asymptomatic. [specialty.mims.com]
Epidemiology
Epidemiology References:[1][2] Epidemiological data refers to the US, unless otherwise specified. [amboss.com]
Thyroid disorders in India: An epidemiological perspective. Indian J Endocrinol Metab. Wolters Kluwer-Medknow Publications. 2011;15(2):S78-81. Usha Menon V, Sundaram KR, Unnikrishnan AG, Jayakumar R V, Nair V, Kumar H. [ijsurgery.com]
Race No convincing epidemiologic studies suggest that race plays an important role in the development of nontoxic goiter. [emedicine.medscape.com]
Pathophysiology
Features of MyAccess include: Remote Access Favorites Save figures into PowerPoint Download tables as PDFs Go to My Dashboard Close • May be a diffuse or a multinodular goiter • May be physiologic or pathophysiologic -Physiologic occurs during puberty [accesssurgery.mhmedical.com]
Long-term studies are needed to define the effects of thyroid hormone suppressive therapy on the growth of goitrous lesions based on their underlying pathophysiology. [ncbi.nlm.nih.gov]
[…] either FNA (based on sonographic criteria) or monitoring (with repeat ultrasounds) if criteria are not met Sonographic criteria for fine-needle aspiration (FNA) References:[1][3] Follicular adenoma Toxic adenoma Toxic multinodular goiter Epidemiology Pathophysiology [amboss.com]
Essentials of pathophysiology: Concepts of altered health states (3rd ed.). Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins. ^ Mitchell, Richard Sheppard; Kumar, Vinay; Abbas, Abul K.; Fausto, Nelson (2007). [en.wikipedia.org]
Prevention
Large goiters occasionally require surgery or iodine-131 to shrink the gland enough to prevent interference with respiration or swallowing or to correct cosmetic problems. Thyroid function is usually normal. [msdmanuals.com]
Prevention: The use of iodized table salt prevents endemic goiter. [uclahealth.org]
Prevention of simple goiter in man. Arch Int Med 1920; 25: 661-672. Marine D. The pathogenesis and prevention of simple or endemic goiter. JAMA 1935; 104: 2334. Bray G.A. [probl-endojournals.ru]
Some, but not all, series suggest that postoperative use of thyroid hormone suppressive therapy prevents recurrence of benign goiter. [ncbi.nlm.nih.gov]