Dr.Lizme Ajith MD(Hom)
Department of Practice of Medicine
Govt. Homeopathic Medical College. Calicut. Kerala
The term ‘GOITRE’ is used to describe generalized enlargement of the Thyroid gland. The normal thyroid gland is impalpable.
Goitre is best classified as –
1) SIMPLE GOITRE-
a) Diffuse Hyperplastic-
b) Colloid Goitre
c) Solitary Nodular
2) TOXIC GOITRE – a) Diffuse (GRAVES DISEASE )
c) Solitary nodular (TOXIC NODULE )
3) NEOPLASTIC GOITRE –
b) Granulomatous Thyroiditis
c) fibrosing Thyroiditis
d) Infective- acute- bacterial or viral chronic- tubercular or syphilitic
5) OTHER RARE TYPES- AMYLOID GOITRE
A thyroid swelling always moves upwards on deglutition. On auscultation a systolic bruit may be heard over the goiter in primary toxic goiter. Exophthalmos and other eye signs are diagnostic of Grave’s disease. Indistinct outline of the swelling, hardness and fixity are diagnostic of neoplastic goiter.
Mid line swellings of the neck include
- ludwig’s angina
- enlarged submental lymph node
- thyroglossal cyst
- sub hyoid bursitis
- retrosternal goiter
- thymic swelling
- dermoid cyst
lateral swellings include
- enlarged sub mandibular salivary gland
- deep plunging ranula
- aneurysm of carotid artery
- carotid body tumour
- branchial cyst
- cystic hygroma
- pharyngeal pouch
- subclavian aneurysm
- aberrant thyroid
THYROID FUNCTION TESTS
1) SERUM T4- The normal range varies from 4-8 microgram/ dl. The level is usually raised in toxic goiters, low in hypothyroidism.
2) SERUM T3- The normal range varies from 150-250 ng/ dl. Toxic goiters show considerably raised levels.
3) SERUM TSH- The normal level is about 5 microunit/ ml. It is raised in hypothyroidism and almost undetectable in thyrotoxic goiters.
4) SERUM PROTEIN BOUND IODINE- The normal range varies from 3.5-8 microgram/dl.
5) T3 RESIN UPTAKE
6) IODINE 131 UPTAKE TEST- The rate at which the thyroid traps iodine reflects the rate of secretion of thyroid hormones. In hyperthyroidism the rate is increased.
7) THYROID SCAN- Scanning with a tracer dose will show which part of the gland is functioning or which is not (hot or cold). I131 and T99 are used.
8) RADIOGRAPHY- Helps to diagnose the position of trachea, retrosternal goiter etc. In case of carcinoma the bones should be X-rayed for evidence of metastasis. Barium swallow X- ray will indicate pressure effect on oesophagus.
9) FINE NEEDLE ASPIRATION CYTOLOGY-Thyroiditis, colloid nodule, benign and malignant tumours can be diagnosed.
10) MISCELLANEOUS TESTS- These include BMR, serum cholesterol, ECG, measurement of tendon reflexes etc.
In early stages a simple goiter may regress on administration of thyroxine. Toxic goiters can be treated by anti thyroid drugs. On cosmetic grounds if goiter is unsightly, surgical resection can be done- Sub Total Thyroidectomy. Neoplastic goiters can be treated by Lobectomy or Total Thyroidectomy.
Simple and exophthalmic goitres. Hard goiter in dark haired persons. Thin and dark complexioned. Scrofulous diathesis. Hypertrophy and induration of glandular tissues except mammae which dwindle and become flabby. Great emaciation. Losing flesh while eating well. Must eat all the time, feels > while eating. Palpitation from least exertion. Tachycardia and tremor. Hot patient.
Exophthalmic goiter. Thyroid gland swollen even with the chin. Swelling and induration of glands. Tubercular diathesis. Palpitation, suffocative paroxysms at night. Dyspnoea as if he had to breath through a sponge. Great dryness of mucus membranes, dry as a horn.
Simple goiter. Hypothyroidism and Myxoedema. Leucophlegmatic, tendency to obesity in youth. Coldness in general, or of single parts. Takes cold easily. Head sweats profusely wetting the pillow far around. Defective assimilation and imperfect ossification. Scrofulous diathesis.
Primary and secondary thyrotoxic goiters.Anaemic and cachetic, loss of vital fluids. Emaciation, losing flesh while eating well. Fluttering of heart. Heart’s pulsation shakes the whole body. Tongue mapped with red insular patches. Craves salt. Bad effects of grief, anger, mortification. <heat of sun,warmth, 10-11 am, seashore.
Myxoedema, Exophthalmic goiter. Anaemia, emaciation, sweating, muscular weakness. Tachycardia, tremor of face and limbs. Palpitation from least exertion. Anxiety about chest as if constricted.
Active principle isolated from thyroid gland. Symptoms similar to Thyroidinum.
Thyroid enlargements at the time of puberty. Scrofulous diathesis. Flabby persons subject to colds. Secretions inclined to be profuse and yellow. Adenoids. Enlarged tonsils filled with crypts.
Hard goiter in fair, light haired, blue eyed persons. Stony hard scrofulous swellings. Indurations. Dryness of mucus membranes. Dyspnoea as if breathing through a sponge. Cold sensation in larynx on inspiration.
Glandular affections with stony hardness. Malignant diseases of the glands of neck. Spongy feeling in throat. Sensation of coldness. Extremely sensitive to cold. A small dry spot in the throat, must sip water frequently. Swelling of glands of the neck like knotted rope.
Indicated in non capsulated goiter when there is a soft doughy feel. Pre ulcerative stage of carcinoma. Glands have a certain elasticity and pliability about them. Fat anaemic persons with ravenous appetite.
Goitre in old maids, old bachelors. Cancerous and scrofulous affections. Glandular indurations of stony hardness. Bad effects of sexual excess. Debility of old people; Complaints caused by a blow or fall. Vertigo when lying down or turning in bed.
Stony hard painful goiter. Pain flying like electric shocks, rapidly shifting. Emaciation, chlorosis, loss of fat. Patients of a rheumatic diathesis. Mercurial or syphilitic affections.
Thyroid gland indurated, swollen, painful. Elderly persons with marked venous plethora. Bluish discolouration. Exhausting discharges. Malignant and ichorous conditions.
Goitre at puberty and pregnancy. Debilitated persons, broken down by excessive use of alcohol. Cachetic and malignant dyscratia. Tongue large shows imprint of teeth. Empty all gone sensation in stomach.
Thyroid gland enlarged. Scrofulous diathesis. Profound prostration, emaciation.Thin watery excoriating discharge from anterior and posterior nares. Exfoliation of skin in large scales.
Glandular swellings, indurations. Acts on fibrous and connective tissues. Haemorrhagic diathesis. Hot persons. Profuse acrid watery discharges.
Exophthalmic goiter following suppression of menses. Scrofulous diathesis. Tumours.Anaemia. Emaciation.
Merc proto iodide
Throat affections, glandular swellings. Right sided. Sensation of a lump. Constant inclination to swallow. Tongue coated thick yellow at the base.
Merc bin iodide
Glandular swellings, left sided. Syphilitic, scrofulous persons. Tongue feels stiff at the base, pain on moving.
Scrofulous diathesis. Deficient nutrition, imperfect assimilation. Inflamation, swelling and suppuration of glands. Ailments from suppressed foot sweats, bad effects of vaccination. Every little injury suppurates.
Thyroid enlargements at puberty. Delayed menses. Weeping disposition. Mild yielding, consolation >. Pains with chilliness, rapidly shifting. Dry mouth without thirst. > open air.
Glands indurated, enlarged. Strumous constitutions.Pains burning stinging sore suddenly migrating. Oedema, bag like puffy swelling under the eyes. Right sided. Hot persons. Oversensitive to touch.
Scrofulous diathesis. Women inclined to obesity, at climacteric. Takes cold easily. Every little injury suppurates. Crakes and fissures. Delayed menses, habitual constipation.
Scrofulous diathesis, persons subject to venous congestion especially of portal system. Lean stoop shouldered. Hot patient. Chronic alcoholism. Burning sensation all over,< heat of bed, night. Empty all gone sensation at 11 am.
Simple goiters. Complaints of old aged, or prematurely old aged. Increased ability to exercise with out danger. Hot persons. Varicose veins and ulcers. Imndifference. Sexual excitement.
Exophthalmic and non toxic goiters. Thyroid enlargements in obese persons. Impaired digestion. Obstinate constipation.
Exophthalmic goiters. Beneficial in toxic goiters, used in the pre operative stages. Lowers the blood pressure, reduces the heart rate.
Grave’s disease or Basedow’s disease. Glands swollen, indurated. Oversensitive to cold. Syphilitic affections.
Exophthalmic goiters, with increased heart’s action and pulsation of arteries. Heat and sweating, tremors and nervousness.Profuse salivation, excessive sweating. Pupils contracted.
Enlarged, indurated glands. Tumours. Stunted growth.
Simple and exophthalmic goiters. Hypertrophy of glands. Tachycardia. Nerve tonic.
Exophthalmic goiters. Anaemia, palpitation, breathlessness. Heart’s action weak, irregular due to muscular debility. Tobacco heart.
Palliative in exophthalmic goiters. Trembling, numbness and weakness. Pupils dilated, dim vision.
Thymus gland extract
High potencies efficient in exophthalmic goiters.
Exophthalmic goiters. Eyes feel pushed out with tumultuous action of heart.