Patient G. Y. F.

65 years old, female, diagnosed with multinodular non-toxic goiter undergone

thyroid surgery with frozen section biopsy.

Anesthesia started: 9:00 am

Surgery Started: 9:00 am
Ended:
1st Specimen: Left Thyroid Lobe Superior 10:48 am
2nd specimen: 11:06 am

Multinodular Non-Toxic Goiter

Goiter term is generally used for defining the enlargement of thyroid gland. Thyroid nodules are
very common and some of these nodules may harbor malignancy. Multinodular goiter (MNG)
disease without thyroid dysfunction is defined as non-toxic MNG.
Multinodular goiter (MNG), characterized as the nodular enlargement of the thyroid gland in the
absence of inflammation, autoimmune thyroid disease, and malignancy, is a frequent thyroid
disorder that affects women more frequently. Iodine deficiency is the most important etiological
factor, but other environmental, hormonal, and genetic elements also play a role in its
pathogenesis.

Causes

One cause of multinodular goiter is an iodine deficiency, although this is rare in the United
States. Iodine is a mineral present in small amounts in a person’s diet.

The thyroid uses iodine to produce its hormones. Without enough iodine, the thyroid cannot
perform its normal functions. For this reason, food manufacturers often add iodine to salt, called
iodized salt, to reduce the prevalence of thyroid dysfunction.

Some people have greater risk factors for developing a multinodular goiter. Risk factors include:

 an iodine deficiency

 genetic factors that affect thyroid hormone production

  sex — women are more likely to develop nodules and thyroid disease

 age — older women are at higher risk of developing thyroid nodules

 a family history of multinodular goiter

 a history of an autoimmune thyroid condition, such as Hashimoto’s thyroiditis or Graves’

disease

If the thyroid gland is not making enough thyroid hormone, the pituitary gland in the brain will
release more of the thyroid-stimulating hormone (TSH). The excess TSH can cause the thyroid
to enlarge and create a multinodular goiter.

Likewise, an overactive thyroid that is making too much thyroid hormone can cause the thyroid
to enlarge and become multinodular.

In some instances, a person may have no known cause for their multinodular goiter.

Surgical Procedure
THYROIDECTOMY
Thyroidectomy is surgical removal of all or part of the thyroid gland, which is located in the
front of the neck. The thyroid gland releases thyroid hormone, which controls many critical
functions of the body.

Thyroid cancer, thyroid nodules and other conditions may require thyroidectomy.
Once the thyroid gland is removed, the person takes replacement thyroid hormone to keep the
body’s functions in balance.
Thyroidectomy can be performed through an incision at the front of the neck, or through the
mouth (scarless thyroidectomy).
Health care providers perform thyroidectomy to treat thyroid disorders. These include cancer,
noncancerous enlargement of the thyroid (goiter) and overactive thyroid (hyperthyroidism).
Why it's done

Your doctor may recommend thyroidectomy if you have conditions such as:

 Thyroid cancer. Cancer is the most common reason for thyroidectomy. If

you have thyroid cancer, removing most or all of your thyroid will likely be a
treatment option.
 Noncancerous enlargement of the thyroid (goiter). Removing all or part
of your thyroid gland may be an option for a large goiter. A large goiter may
be uncomfortable or make it hard to breathe or swallow. A goiter may also
be removed if it's causing your thyroid to be overactive.
 Overactive thyroid (hyperthyroidism). In hyperthyroidism, your thyroid
gland produces too much of the hormone thyroxine. Thyroidectomy may be
an option if you have problems with anti-thyroid drugs, or if you don't want
radioactive iodine therapy. These are two other common treatments for
hyperthyroidism.
 Suspicious thyroid nodules. Some thyroid nodules can't be identified as
cancerous or noncancerous after testing a sample from a needle biopsy. If
your nodules are at increased risk of being cancerous, you may be a
candidate for thyroidectomy.