Thyroid enlargement
Thyroid enlargement: Excerpt from Signs & Symptoms: A 2-in-1 Reference for Nurses
An enlarged thyroid can result from inflammation, physiologic changes, iodine deficiency, and thyroid tumors. Depending on the medical cause, hyperfunction or hypofunction may occur with resulting excess or deficiency, respectively, of the hormone thyroxine. If no infection is present, enlargement is usually slow and progressive. An enlarged thyroid that causes visible swelling in the front of the neck is called a goiter.
History
The patient’s history commonly reveals the cause of thyroid enlargement. Important data includes a family history of thyroid disease, when the thyroid enlargement began, any previous irradiation of the thyroid or the neck, recent infections, and the use of thyroid replacement drugs.
Physical assessment
Begin the physical assessment by inspecting the patient’s trachea for midline deviation. Although you can usually see the enlarged gland, you should always palpate it. (See Palpating the thyroid gland, page 650.)
During palpation, be sure to note the size, shape, and consistency of the gland, and the presence or absence of nodules. Using the bell of a stethoscope, listen over the lateral lobes for a bruit. The bruit is usually continuous.
Medical causes
Hypothyroidism
Besides an enlarged thyroid, signs and symptoms of hypothyroidism include weight gain despite anorexia; fatigue; cold intolerance; constipation; menorrhagia; slowed intellectual and motor activity; dry, pale, cool skin; dry, sparse hair; and thick, brittle nails. Eventually, the face assumes a dull expression with periorbital edema.
CULTURAL CUE:Goiters are common in areas of the world that are deficient in iodine, such as Asia, Latin America, Africa, and parts of Europe.
Thyroiditis
Autoimmune thyroiditis usually produces no symptoms other than thyroid enlargement. In subacute granulomatous thyroiditis, moderate thyroid enlargement may follow an upper respiratory infection or a sore throat. The thyroid may be painful and tender. Dysphagia may also occur.
Thyrotoxicosis
One of the classic features of thyrotoxicosis is an enlarged thyroid gland. Associated signs and symptoms include nervousness; heat intolerance; fatigue; weight loss despite increased appetite; diarrhea; sweating; palpitations; tremors; smooth, warm, flushed skin; fine, soft hair; exophthalmos; nausea and vomiting due to increased GI motility and peristalsis; and, in females, oligomenorrhea or amenorrhea.
Tumors
An enlarged thyroid may result from a malignant tumor or a nonmalignant tumor (such as an adenoma). A malignant tumor usually appears as a single nodule in the neck; a nonmalignant tumor may appear as multiple nodules in the neck. Associated signs and symptoms include hoarseness, loss of voice, and dysphagia.
Other causes
Goitrogens
Goitrogens are drugs and substances in foods that decrease thyroxine production. Drugs include lithium, sulfonamides, phenylbutazone, and para-aminosalicylic acid. Foods containing goitrogens include peanuts, cabbage, soybeans, strawberries, spinach, rutabagas, and radishes.
Special considerations
Prepare the patient with an enlarged thyroid for tests, such as needle aspiration, ultrasound, and radioactive thyroid scanning. Also prepare him for surgery or radiation therapy, if necessary.
The hypothyroid patient will need a warm room and moisturizing lotion for his skin. A gentle laxative and stool softener may help with constipation. Provide a high-bulk, low-calorie diet, and encourage activity to promote weight loss. Warn the patient to report any infection immediately; if he develops a fever, monitor his temperature until it’s stable. After thyroid replacement begins, watch for signs and symptoms of hyperthyroidism, such as restlessness, sweating, and excessive weight loss. Avoid administering a sedative, if possible, or reduce the dosage because hypothyroidism delays metabolism of many drugs.
For patients with thyroiditis, give an antibiotic and watch for elevations in temperature, which may indicate developing resistance to the antibiotic. Examine the patient’s neck for unusual swelling or redness. Provide a liquid diet if the patient has difficulty swallowing. Check for signs of hyperthyroidism, such as nervousness, tremor, and weakness, which are common with subacute thyroiditis. The patient with severe hyperthyroidism (thyroid storm) will need close monitoring of temperature, volume status, heart rate, and blood pressure.
After thyroidectomy, check vital signs every 15 to 30 minutes until the patient’s condition stabilizes. Be alert for signs of tetany secondary to parathyroid injury during surgery. Monitor postoperative serum calcium levels, and keep 10% calcium gluconate available for I.V. use as needed. Evaluate dressings frequently for excessive bleeding, and watch for signs of airway obstruction, such as difficulty in talking, increased swallowing, or stridor. Keep tracheotomy equipment handy.
Pediatric pointers
Congenital goiter, a syndrome of infantile myxedema or cretinism, is characterized by mental retardation, growth failure, and other signs and symptoms of hypothyroidism. Early treatment can prevent mental retardation. Genetic counseling is important because subsequent children are at risk.
Patient counseling
Instruct the patient to watch for signs and symptoms of hypothyroidism, such as lethargy, restlessness, dry skin, and sensitivity to cold. If the patient has Graves’disease, proptosis may cause his eyes to become dry, so advise him to use artificial tears frequently. If the hyperthyroid patient is receiving therapy with radioactive iodine, tell him not to expectorate or cough freely after treatment because his saliva is radioactive for 24 hours. If the patient has a goiter, support him as he expresses his feelings related to his appearance.
After thyroidectomy or radioactive destruction of the thyroid gland, explain to the patient that lifelong thyroid hormone replacement therapy is necessary. Tell him to watch for signs of overdose, such as nervousness and palpitations.
Pictures
Book Source Details
- Book Title: Signs & Symptoms: A 2-in-1 Reference for Nurses
- Author(s): Springhouse
- Year of Publication: 2007
- Copyright Details: Signs & Symptoms: A 2-in-1 Reference for Nurses, Copyright © 2007 Lippincott Williams & Wilkins.
More About Goiter
More Medical Textbooks Online about Goiter
Review other book chapters online related to Goiter:
Medical Books Excerpts
- Thyroid Nodule
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Goiter
- "The 5-Minute Pediatric Consult" (2008)
- [ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
» Next page: Scrotal Enlargement (The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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