INTRODUCTION

Goiter is an enlargement of the thyroid gland. The thyroid can be enlarged due to generalized
enlargement of the thyroid or nodules (tissue growths) within the thyroid. The thyroid gland produces the
hormones thyroxine (also called T4) and a small amount of triiodothyronine (also called T3). These thyroid
hormones influence such bodily functions as a person’s body temperature, mood and excitability, pulse rate,
digestive functions, and other processes necessary for life. Goiters have different causes depending on their type.
Goiters can be classified as simple, hereditary, or due to other causes. Simple goiters are caused by an
inadequate supply of thyroid hormone to meet the body’s need. The thyroid gland tries to make up for this
deficiency by enlarging. Endemic goiters occur in people within certain geographic areas who do not get enough
iodine in their diet (iodine is necessary to make thyroid hormone). Sporadic goiters in most cases have no
known cause. Sometimes certain types of drugs, such as lithium or aminoglutethimide, can cause this type of
goiter.

Risk factors for goiter development include gender mostly to female with an age 40 and above, family
history of goiter other diseases and conditions can also cause a goiter. These include grave’s disease,
hashimoto’s disease, nodular goiter, thyroid cancer, pregnancy, thyroiditis, and exposure to radiation.

Main symptoms include swelling, ranging in size from a small nodule to a massive lump, in the front of
the neck just below your Adam’s apple, a feeling of tightness in the throat area, difficulty breathing, coughing,
wheezing, dysphagia, hoarseness, distended neck vein. Other symptoms includes signs of hyperthyroidism -- a
condition in which the thyroid is overactive includes an increased resting pulse rate, rapid heartbeat, diarrhea,
nausea, vomiting, sweating without exercise or increased room temperature, shaking, and agitation. On the other
hand symptoms includes signs of hypothyroidism are fatigue, constipation, dry skin, weight, menstrual
irregularities

Several testing methods can be used to diagnose and evaluate the goiter, including: Physical exam ; it
may be able to determine enlargement of the thyroid gland by feeling your neck area for nodules and signs of
tenderness, hormone test, a blood test to determine thyroid hormone levels. antibody test, ultrasound of the
thyroid, Thyroid scan , and CT scan or MRI

Treatment options depend on the size of the enlargement, your symptoms, and the underlying cause.
Medications; Levothyroxine is a thyroid hormone replacement therapy. Aspirin or a corticosteroid medication
might be prescribed if the underlying cause of your goiter is inflammation. Small doses of iodine can be
prescribed if the goiter is due to iodine deficiency. Radioactive iodine treatment, is another treatment, used in
cases of an overactive thyroid gland. Biopsy may be required if you have large nodules in the thyroid to exclude
cancer. Thyroidectomy surgery,to remove all or part of the thyroid gland, may be necessary if the goiter is large
and causing difficulty with breathing and swallowing.

Disorders of thyroid function, whether hyperthyroidism or hypothyroidism are medical conditions that
can have a significant impact on public health and can even shorten the lifespan of individuals of any age.
Thyroid disorders, goitrous and non goitrous forms, occur with great frequency in the adult population ranging
from 0.5 to 5% in overt disease and 3 to 10% in the subclinical forms depending on the population, age and sex
examined. While, lack of dietary iodine is an important underlying cause of thyroid disorders, excess iodine,
genetic background, other geographical and dietary factors can trigger thyroid disorders.
 NURSING HISTORY

Biography Data

This is the case of Z.D. 58 years of age, born on July 30 1953, widow,and Roman Catholic who is
currently residing at Panginay, Balagtas, Bulacan.she was admitted at Bulacan Medical Center on November 20,
2011, 10:19 in the morning of Dr. Alfonso Reiner.

Chief Complain: Enlarged Thyroid

PRESENT HEALTH HISTORY

4 Years PTA, the patient was experiencing uncontrolled cough daily she always feel irritable and quite
abdominal pain. No medication taken or consultation was sought.

3 Years PTA the patient still experience persistent cough and Nausea and vomiting. But still she didn’t
seek for consultations due to lack of financial problem. Eventhough she felt that there is mass palpated on her
neck.

2 years PTA the patient felt difficulty of breathing specially during lying on the bed still cough is
present. She is also experience difficulty a swallowing.

1year PTA the patient sought consultation to a physician with her daughter. She was offer for an
operation but they refuse because they were not yet prepared.

1 month PTA ZD due to enlarged neck mass they again sought for consultation and undergone a
hormone examination and electrolyte exam. Then they wait for result.

1 day PTA, ZD was waiting for her schedule for surgical operation and preparing for the things she
needed.

PAST HEALTH HISTORY

ZD was hospitalized when she as 38 years old also due to goiter. She was already legated before turning
40 years old. No past record of accident or injuries. No allergy.

LIFE STYLE

ZD is living with her daughter and son-in-law with her grandchildren. She spends her day doing
household chores daily (laba, luto, linis bahay). She was difficulty in sleeping, 5 hours of sleep pattern. The
patient is taking vitamins enervon, sometimes centrum. She was take 8 glasses of water a day. Non- smoker and
non- alcoholic drinker. Do not like to eat repolyo, sitaw, and sayote, and seafood’s like seaweeds.

FAMILY HISTORY

The patient’s mother –side have a history siblings died from Breast Cancer. On her father- side, they
have history of hypertension.
PHYSICAL ASSESSMENT & FINDINGS
Area to be Technique Findings Significance Findings Significance
examined Nov 22,2011 Nov 28,2011
BP:150/90 BP:140/80
Vital signs: PR:99 PR:86
RR:29 RR:21
TEMP:38.1 TEMP:37.2

HEAD Inspection -Round & - Findings are -Round & - Findings are
Palpation Symmetric normal Symmetric normal
-no masses -no masses
-hairs are -hairs are
equally equally
distributed with distributed with
many visible many visible
white hairs white hairs
-with freckles -with freckles
surrounding her
face

EYES Inspection -asymmetrically - Findings are -asymmetrically - Findings are

Palpation aligned normal aligned normal
-no edema -no edema
-narrowed -narrowed
visual acuity visual acuity
-pupil reacts to -pupil reacts to
stimuli stimuli

NOSE Inspection -intact nasal - Findings are -intact nasal - Findings are
Palpation mucosa normal mucosa normal
-no nodules nor -no nodules nor
masses masses
- nares are - nares are
symmetrical symmetrical

EARS Inspection -symmetrically -uncleaned -symmetrically -uncleaned

Palpation aligned external ear aligned external ear
-auricles with canal -auricles with canal
outer canthus of outer canthus of
the eye -other findings the eye -other findings
-mobile and are normal -mobile and are normal
firm firm
-no tenderness -no tenderness
- contain some - clean ear
cerumen canal; absence
of cerumen

MOUTH Inspection -symmetry of -Due to old age -symmetry of -Due to old age
Palpation countour countour
- uniform in -Other findings - uniform in -Other findings
color are normal color are normal
-dry lips -dry lips
-missing teeth -missing teeth
-tongue moves -tongue moves
freely freely
-no palpable -no palpable
nodules nodules

NECK Inspection -head centered -The patient -head centered -The patient
palpation -with enlarged undergone -with dry and undergone
lymph node complete intact dressing complete
-with jackson’s thyroidectomy - gland is not thyroidectomy
pratt drainage last Nov 21, visible even in last Nov 21,
-with intact 2011 swallowing 2011
dressing
-complain for -other findings -other findings
Conclusion:

The gathered data through Physical Assessment mostly shows normal findings except to the incision
site on the neck part. Because , the patient Z.D. was undergone a surgery of Complete Thyroidectomy, last
November 21, 2011.

ANATOMY & PHYSIOLOGY

The thyroid is a butterfly-shaped gland that sits low on the front of the neck. Your thyroid lies
below your Adam’s apple, along the front of the windpipe. The thyroid has two side lobes, connected
by a bridge (isthmus) in the middle. When the thyroid is its normal size, you can’t feel it.
Brownish-red in color, the thyroid is rich with blood vessels. Nerves important for voice quality also
pass through the thyroid.
The thyroid secretes several hormones, collectively called thyroid hormones. The main
hormone is thyroxine, also called T4. Thyroid hormones act throughout the body, influencing
metabolism, growth and development, and body temperature. During infancy and childhood, adequate
thyroid hormone is crucial for brain development.

PATHOPHYSIOLOGY

MODIFIABLE NON-MODIFIABLE
Lifestyle; low iodine Gender: Female
diet Age: 58 y/o
Hyperthyroidism

Iodine deficiency

Decrease synthesis of thyroid

hormone

Decrease release of
T3 &T4

Sends signal to pituitary

gland

Increase release of

Increase cellularity of thyroid

Hyperplasia of Thyroid
Gland
Pain Visible neck mass
 Wheezing &
Hoarseness
Coughing & DOB

Fatigue

Dysphagia & weight

loss

GOITE
R

LABORATORY EXAMINATIONS

Chemistry Result Form

October 25, 2011

Constipation & Dry
Test Name Result Interpretation Skin
Ranges Significance

Biochem Glucose 5.5 mmo / L Normal 3.8 – 6.0 Normal

Hexoki

Creatinine
81.3 Normal 35.4 – 123.8 Normal
Kinetic 2
GOITER
Sodium 141.9 135-148mmol/L Normal
Potassium 4.59 3.5-5.3 mmol/L Normal
Calcium - 1.1-1.32 None
Chloride 107.7 96-107

Thyroid Profile
October 26, 2011

Test Results Normal

T3 - None
T4 - None
TSH 5.4 0.4-5.5 uiu/mL
FT4 22.7 9.0-23.0 pmol/L
FT3 0.1 3.5-6.5 pmol/L

Electrolytes Result
November 23, 2011
 Sodium 138.1 135-148mmol/L Normal
Potassium 3.09 3.5-5.3 mmol/L Normal
Calcium 1.15 1.1-1.32 Normal
Chloride - 96-107 None

Radiologic Report
October 21, 2011
Lung is clear. The heart is enlarged, the aorta is tortuous and calcified. The hemidiaphragms &
costophrenic sulci is intact.

Impression: CARDIOMEGALY
ATHEROMATOUS AORTA

HEALTH TEACHINGS

-Instruct the patient to take the prescribe medications.

-Teach the patient on how to take the medicine in the right time, right
M dose and right route as prescribed by the physician.
-Educate the client about the effect of her medication.

-Promote a calm and clean environment.

-Encourage the relative to promote good ventilation and free from
E pollution environment.
-Promote an infection-free environment by cleaning the surroundings.

-Advise the patient and as well as the relatives to have a healthy

lifestyle.
-Advise the patient to avoid smoking area and avoid alcohol beverages
T intake.
-Instruct the patient to use povidone solution in cleaning her wound
incision site.

-Encourage the patient to have a daily wound care.

-Encourage the patient to have a proper hygiene by taking a bath and
H hand washing using water and mild soap.
-Encourage the patient to have a clean and aseptic dressing technique to
her wounds to prevent contamination.

O -Advise the patient to have a monthly check-up to a physician.

-Encourage the patient for the compliance of her take home
medications.
-Encourage the patient to maintain her healthy condition.
 -Advise the patient to eat foods rich in iodine, like sea foods &
D nutritious foods that will make her healthy.
-Advise the client to have a proper diet and adequate fluid intake.

-Provide safety by keeping things in the right place specially those

which can injured.
S -Encourage the relatives to be sensitive enough about the things that
can harm the patient.
-Be careful all the time.

OBJECTIVE

This case study aims to identify & determine the needs of the patient. This is also intends to help patient

promote healthy lifestyle and understand such condition through application of the nursing skills and for the

students to gain knowledge, skill & attitude.

At the end of this case study, the students will be able to:

• Discuss about Goiter

• Analyze the Pathophysiology of Goiter

• Interpret laboratory result of the patient with Goiter

• Formulate the Nursing Care Plan & Health teachings to promote wellness of the client.

• Evaluates Physical Assessment Findings.

 EVALUATION

This study enables the students to identify& determine the needs of the patient with Goiter who

undergone Complete Thyroidectomy. It is also helped the patient to promote his healthy lifestyle through

understanding his condition and through the application of the nursing skills, the students gained knowledge,

skills and enhance good attitude.

Specifically the student nurses now able to:

• Discuss the Goiter

• Analyze the Pathophysiology of Goiter

• Interpret laboratory result of the patient with Goiter

• Formulate the Nursing Care Plan and health teachings promote wellness of the client .

• Evaluates Physical Assessment Findings

Dr. Yanga’s Colleges Inc.
Wakas, Bocaue, Bulacan

A CASE STUDY

(SURGICAL WARD)

Submitted by:

PRINCESS JOY T. CORTEZ

Group 9