Thyroid – Goiter

If there is a disorder of the thyroid gland, the word “goiter” is commonly used.

A goiter or a disorder of the thyroid gland is said to be present if there are structural and functional abnormalities.

Structural wise, if the thyroid gland is abnormally enlarged and there are nodules or masses.

Functional wise, if the patient is hypothyroid or hyperthyroid.

There are different ways of interpreting the size of the thyroid gland.  One is by palpation (or physical examination). Another is by imaging procedures.  The most common imaging procedure being done nowadays is an ultrasound of the thyroid gland.  Unless there thyroid gland is obviously enlarged, there is usually a discrepancy in the interpretation of thyroid enlargement between physician-clinician ‘s findings and physician-ultrasonographer’s findings.  A physician-clinician uses a different basis for interpretation of thyroid enlargement – based on palpation (if the thyroid is not palpable or barely or slightly palpable – the clinical diagnosis is that the thyroid gland is not enlarged).  A physician-ultrasonographer uses a different basis for interpretation of thyroid enlargement – ultrasound measurement of the length – height – width in cm’s of the thyroid gland (if the measurement is above the average Filipino size –  length 3.2-3.9 cm – width and height – 1.0 – 1.5 cm – the interpretation is that the thyroid gland is enlarged).

Again, there are different ways of interpreting the presence or absence of thyroid nodules. One is by palpation (or physical examination). Another is by imaging procedures.  The most common imaging procedure being done nowadays is an ultrasound of the thyroid gland.  Again, there may be discrepancy in the interpretation of presence or absence of thyroid nodule between physician-clinician’s findings and a physician-ultrasonographer’s findings.   If a dominant mass is palpated by the physician-clinician, then the clinical diagnosis is the presence of thyroid nodule. If none, none.  If a nodule is detected on the basis of sound waves, then the ultrasound diagnosis is the presence of thyroid nodule.  If none, none.  The limitation of a physician-clinician’s physical examination is that small and deep thyroid nodules are usually not palpable.  The limitation of a physician-ultrasonographer is usually false-positive reading of nodules, particularly “solid” nodules.

Disorders in function, hypothyroid or hyperthyroid, can be recognized clinically or by the thyroid function tests.  Signs and symptoms of hyperthyroid and hypothyroid may or may not be clinically evident.  If there is a clinical suspicion of thyroid function disorder, thyroid function tests are usually done.  The more common thyroid function tests being done are FT4 and TSH.

ROJ-TPOR@17mar11

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