Health

Empowerment
Disorder
objective - for
Course–
laypeople to have an
Fundamentals
understanding of the
and
FUNDAMENTALS
Generalities in
and GENERALITIES in
Medical
the MEDICAL
Management
MANAGEMENT of
of Goiter –
GOITER – Part 2.
Part 2
 February 12, 2022
Health 1400H - 1500H
Empowerment Via Zoom
Disorder
objective - for
Course–
laypeople to have an
Fundamentals
understanding of the
and
FUNDAMENTALS
Generalities in
and GENERALITIES in
Medical
the MEDICAL
Management
MANAGEMENT of
of Goiter –
GOITER – Part 2.
Part 2
 Health
Empowerment ROJoson PEP Talk
Disorder
objective - for
Course– I have a Patient
laypeople to have an
Fundamentals Empowerment
understanding of the
and Program in which I
FUNDAMENTALS
Generalities in like to empower the
and GENERALITIES in lay people or
Medical
the MEDICAL patients to take
Management
MANAGEMENT of control in the
of Goiter – management of
GOITER – Part 2.
Part 2 their health.
 There are 3 courses
in the PEP Talk.
I completed the Core
Course on October 9,
2021.
 From October 23,
2021 onwards, I have
been tackling Health
Disorder and Health
Issue Courses. This
may take 3 years or
longer.
 My PEP TALK today
Health is entitled:
Empowerment
Disorder Fundamentals and
objective - for
Course– Generalities in
laypeople to have an
Fundamentals Medical
understanding of the Management of
and
FUNDAMENTALS GOITER, Part 2. This
Generalities in
and GENERALITIES in is part of the Health
Medical
the MEDICAL Disorder Course.
Management
MANAGEMENT of
of Goiter –
GOITER – Part 2.
Part 2
Fundamentals Contents: PART 1
and • What is a goiter?
Generalities in • What are the common types of goiter?
Medical • What are the causes of goiter?
• How common are the goiters?
Management
of Goiter
Fundamentals Contents: PART 2
and • Clinical diagnosis of goiter
Generalities in • Paraclinical diagnostic procedures for goiters
Medical
Management
of Goiter

• Treatment for goiters

• Health restoration and maintenance
PART 3
Fundamentals Definition of Terms in Title AND Delimitation of
and Coverage of Talk:
Generalities in
Fundamentals – simplest and essential facts and
Medical theories which can serve as a basis or foundation
Management and support for advanced information
of Goiter
Generalities – general statements of info, not
covering specifics and details

Medical Management – diagnosis and treatment

by physicians
Fundamentals Clinical Diagnosis of Goiter
and
Clinical diagnosis means a conclusion or
Generalities in
decision made by a physician after
Medical
examining a patient and after evaluation of
Management
the data on symptoms and signs.
of Goiter
Symptoms are what are felt and observed
by the patient or a person on the body.

Signs are findings of a physician after

physical examination of a patient.
Fundamentals Clinical Diagnosis of Goiter
and
Generalities in
Medical
Management
of Goiter
Fundamentals Clinical Diagnosis of Goiter
and
Procedures in clinical diagnosis of goiter:
Generalities in Patient has symptoms.
Medical • Physician evaluates the symptoms to look for
Management cues for a goiter and then cues or pattern for a
of Goiter particular goiter disease.
• Physician does physical examination to look for
sign-cues for a goiter and cues or pattern for a
particular goiter disease.
• Physician processes symptoms and signs to
determine 1) whether a goiter is present and 2)
if present, what is the goiter disease.
Fundamentals Clinical Diagnosis of Goiter
and
Processes used in clinical diagnosis of
Generalities in
goiter:
Medical
Management • Pattern recognition
of Goiter • Prevalence
Fundamentals Clinical Diagnosis of Goiter
and
Processes used in clinical diagnosis of
Generalities in
goiter:
Medical • Pattern recognition process means realization
Management that the patient’s presentation conforms to a
of Goiter previously learned picture or pattern of
disease.
• Prevalence process means choice of a diagnosis
is based on the frequency of occurrence of the
disease in a certain locality, in a certain age and
sex group, and in the affected organ and
system.
Fundamentals Clinical Diagnosis of Goiter
and Common symptoms that will lead to
Generalities in suspected presence of goiter
Medical
Management • Lump/s on the front, base and central
of Goiter part of the neck which moves up and
down with swallowing
• Lump/s on the side of the neck
• Palpitation
• Sudden weight loss
• Persistent fatigue
Fundamentals Clinical Diagnosis of Goiter
and Common symptoms that will lead to
Generalities in suspected presence of goiter
Medical
Management Persistent fatigue
of Goiter
A cue or alert-signal for HYPOTHYROIDISM
Fundamentals Clinical Diagnosis of Goiter
and Common symptoms that will lead to
Generalities in suspected presence of goiter
Medical
Management • Palpitation
of Goiter • Sudden weight loss

Cues or alert-signals for

HYPERTHYROIDISM
Fundamentals Clinical Diagnosis of Goiter
and Common symptoms that will lead to
Generalities in suspected presence of goiter
Medical
Management • Lump/s on the front, base and central
of Goiter part of the neck which moves up and
down with swallowing
• Lump/s on the side of the neck

Cues or alert-signals for tumors which

could be benign or malignant (need more
sign-cues)
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
Medical After a patient tells me her/his symptoms
Management which may suggest a GOITER,
of Goiter
I examine right away the neck and check
the pulse rate.

I additionally gather other data as

indicated with the goal of more specific
and accurate clinical diagnosis.
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
After examining the neck and checking the pulse
Medical Clinical Diagnosis:
rate (and gathering other indicated data), I have
Management these possible situations: Normal Thyroid
of Goiter • Thyroid gland is not palpable.
• Thyroid gland is not enlarged.
• There is/are no nodule/s on the thyroid gland.
• There are no neck nodes.
• Pulse rate is less than 90/min (normal).
• No symptom-cues for hyperthyroidism and
hypothyroidism
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
After examining the neck and checking the pulse
Medical Clinical Diagnosis:
rate (and gathering other indicated data), I have
Management these possible situations: GOITER
of Goiter which has to be
• The thyroid gland is palpable.
• The thyroid gland is enlarged.
evaluated further
• There is /are nodule/s on the thyroid gland. for more specific
diagnosis
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in Clinical Diagnosis:
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have
Management these possible situations:
of Goiter NON-TOXIC
• There is a goiter.
• If the pulse rate is less than 90/min GOITER

• If the pulse rate is ≥ 90/min TOXIC GOITER

Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
After examining the neck and checking the pulse Clinical Diagnosis:
Medical rate (and gathering other indicated data), I have
Management these possible situations:
of Goiter TOXIC GOITER
• There is a goiter.
• The thyroid is diffusely enlarged. HYPERTHYROIDISM
• The pulse rate is ≥ 90/min

• Tremors

• Bulging eyes GRAVES’ DISEASE

Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have Clinical Diagnosis:
Management these possible situations:
of Goiter
• There is a goiter. NON-TOXIC
• The thyroid is diffusely enlarged. GOITER
• The pulse rate is < 90/min
• There is persistent fatigue.
HYPOTHYROIDISM
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have Clinical Diagnosis:
Management these possible situations:
of Goiter
• There is a goiter. NON-TOXIC
• The thyroid is diffusely enlarged. GOITER
• The pulse rate is < 90/min
DIFFUSE COLLOID
• There is adequate intake of iodine-rich foods. ADENOMATOUS
• There is NO history of persistent fatigue. GOITER
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have Clinical Diagnosis:
Management these possible situations:
of Goiter
• There is a goiter. NON-TOXIC
• The thyroid is diffusely enlarged. GOITER
• The pulse rate is < 90/min
IODINE-
DEFICIENCY
• There is inadequate intake of iodine-rich foods. GOITER
Fundamentals Clinical Diagnosis of Goiter Clinical Diagnosis:
and ROJoson Way of Evaluation
Generalities in NON-TOXIC
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have
GOITER
Management these possible situations: which has to be
of Goiter • There is a goiter.
evaluated further
• The thyroid has nodule/s. for more specific
• The pulse rate is < 90/min diagnosis
(cancer or NOT
cancer)
Fundamentals Clinical Diagnosis of Goiter Clinical Diagnosis:
and ROJoson Way of Evaluation
Generalities in NON-TOXIC
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have
GOITER
Management these possible situations:
of Goiter • There is a goiter.
THYROID CANCER
• The thyroid has nodule/s. which has to be
• The pulse rate is < 90/min evaluated further
• Positive for cues for malignancy: for more specific
• Hard nodule/s type of cancer
• Fixed; hoarseness of voice
• Neck nodes / distant mass
Fundamentals Clinical Diagnosis of Goiter Clinical Diagnosis:
and ROJoson Way of Evaluation
Generalities in NON-TOXIC
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have
GOITER
Management these possible situations:
of Goiter • There is a goiter.
THYROID CANCER
• The thyroid has nodule/s.
• The pulse rate is < 90/min PAPILLARY
• Positive for cues for malignancy: CANCER
• Hard nodule/s
• Fixed; hoarseness of voice
• Neck nodes
Fundamentals Clinical Diagnosis of Goiter Clinical Diagnosis:
and ROJoson Way of Evaluation
Generalities in NON-TOXIC
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have
GOITER
Management these possible situations:
of Goiter • There is a goiter.
THYROID CANCER
• The thyroid has nodule/s.
• The pulse rate is < 90/min FOLLICULAR
CANCER
• Positive for cue for malignancy:
• Distant mass suspicious for metastasis
Fundamentals Clinical Diagnosis of Goiter Clinical Diagnosis:
and ROJoson Way of Evaluation
Generalities in NON-TOXIC
After examining the neck and checking the pulse
Medical rate (and gathering other indicated data), I have
GOITER
Management these possible situations:
of Goiter • There is a goiter.
BENIGN
• The thyroid has nodule/s. COLLOID
• The pulse rate is < 90/min ADENOMATOUS
• NO cues for malignancy: GOITER
• Hard nodule/s
• Fixed; hoarseness of voice
• Neck nodes / distant mass
Fundamentals Clinical Diagnosis of Goiter
and ROJoson Way of Evaluation
Generalities in
Disclosures:
Medical I have been using ROJoson Way of Evaluation for
Management more than 40 years now.
of Goiter
My batting average:

>95% accuracy in my clinical diagnosis.

The <5% error I corrected right away with
paraclinical diagnostic procedure – to make it
100% accuracy in the end.
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in
Medical
Management
of Goiter
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in
Medical The foremost indication for a paraclinical
Management diagnostic procedure can be stated this
of Goiter way:

if you are not certain on the primary

clinical diagnosis and you need to be
certain or be more certain before
treatment, then go for a paraclinical
diagnostic procedure.
Fundamentals Paraclinical Diagnostic Procedures for
As a rule, there is no need
and Goiters for a paraclinical
Generalities in diagnostic procedure if:
To decide on indication of the paraclinical
Medical • you are quite
diagnostic procedure,
Management certain of your
of Goiter the physician uses two processes – primary clinical
- degree of certainty on the primary diagnosis.
clinical diagnosis and • treatment plans for
primary and
- comparison of the treatment plans for
secondary
the primary and secondary clinical diagnoses are the
diagnoses. same.
Fundamentals Paraclinical Diagnostic Procedures for
If there is a need for a
and Goiters
paraclinical diagnostic
Generalities in procedure, the
Procedures Benefit Risk Cost Availability
Medical (goal – to
physician uses the B-
be more
Management definite on R-C-A processes.
of Goiter the
diagnosis) B – stands for benefit;
R – risk; C – cost; A –
Option1         Availability.
Option2        
Option3        
Fundamentals Paraclinical Diagnostic Procedures for
The physician gives or
and Goiter
lists the various
Generalities in options of paraclinical
Procedures Benefit Risk Cost Availability
Medical (goal – to
diagnostic procedures
be more
Management definite on and then gives data
of Goiter the
diagnosis) on the BRCA.
With the data given,
Option1         the patient is asked
Option2        
what s/he prefers.
Option3        
Fundamentals Paraclinical Diagnostic Procedures for Example of BRCA
and Goiters comparative analysis
Generalities in of paraclinical
Medical diagnostic procedures
Management
Procedures Benefit (goal – to be Risk Cost (PhP) Availability
of Goiter more definite on the
diagnosis)

Option1 accuracy 99% acceptable 4000 available

Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Common instrumental and laboratory diagnostic
Medical procedures that can be used after the clinical
Management diagnosis of goiter:
of Goiter • Thyroid function tests – FT3, FT4, TSH
• Imaging procedures – ultrasound, thyroid scan,
CT Scan, MRI, PET Scan
• Needle aspiration ± biopsy
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Competencies required of physicians managing
Medical goiters:
Management • Know the uses and indications of all known
of Goiter instrumental and laboratory diagnostic
procedures for goiter.
• Use as needed and indicated.
• Select the most cost-effective one.
• Know how to interpret the results.
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Thyroid function tests – FT3, FT4, TSH
Medical
to check level of thyroid hormones in the blood –
Management euthyroid; hyperthyroid; hypothyroid.
of Goiter
Indications:
• when not sure whether a patient has
hyperthyroid or hypothyroid
• when needed to have a baseline and follow-up
values to monitor subsequent medical
treatment
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Thyroid function tests
Medical
Interpretations:
Management
• Normal FT4 and normal TSH – euthyroidism
of Goiter
• Elevated FT4 and below normal TSH –
hyperthyroidism
• Below normal FT4 and elevated TSH -
hypothyroidism
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Imaging procedures – ultrasound, thyroid scan, CT
Medical Scan, MRI, PET Scan
Management
of Goiter
Indication:
When needed to evaluate the structure
(ultrasound, CT Scan, MRI) and at times, function
of the thyroid gland (thyroid scan and PET Scan)

THYROID SCAN
Choose the most cost-effective ones.
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Imaging procedures – ultrasound, thyroid scan, CT
Medical Scan, MRI, PET Scan
Management
of Goiter
Indication:
Ultrasound, CT scan, MRI can be used to evaluate
the structure - size of the thyroid gland and
whether a nodule present is benign or malignant.

Choose the most cost-effective ones.

Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Imaging procedures – ultrasound, thyroid scan, CT
Medical Scan, MRI, PET Scan
Management
of Goiter
Indication:
Thyroid scan using a radioactive isotope is used
primarily to determine whether there is nodule
that is hyperfunctioning or not.

THYROID SCAN
Choose the most cost-effective ones.
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Needle aspiration ± biopsy
Medical
Management
of Goiter Indications:
• When needed to determine whether a nodule
is solid or cystic (if cystic, needle aspiration
may be therapeutic in outcome)
• When needed to get a sample of solid nodule
for biopsy (whether benign or malignant - at
times the specific disease can be revealed)
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in Competencies required of physicians managing
Medical goiters:
Management • Know the uses and indications of all known
of Goiter instrumental and laboratory diagnostic
procedures for goiter.
• Use as needed and indicated.
• Select the most cost-effective one.
• Know how to interpret the results.
Fundamentals Paraclinical Diagnostic Procedures for
There are several
and Goiters
issues to discuss in the
Generalities in Issues: use of paraclinical
Medical • Ordering tests not needed for diagnosis of goiter diagnostic procedures
Management • Shotgun approach ordering every possible test just to in GOITER.
of Goiter catch a specific diagnosis of goiter
• Inaccurate results
There are a lot of
• Not knowing how to interpret results
confusion, not to say
• Using the fad, the popular one without comparative errors, happening.
analysis (benefit, risk, cost and availability) of other
options (usually with no considerations for cost-
effectiveness and patient preference)
Fundamentals Paraclinical Diagnostic Procedures for Issues:
and Goiters • Ordering tests not
Generalities in Ordering thyroid function tests and thyroid needed for
Medical ultrasound in one GO in one package for all diagnosis of goiter
Management patients with GOITER. • Shotgun approach
of Goiter - Shotgun approach ordering every
- Patients with nodules with no symptoms of possible test just
hyperthyroidism or hypothyroidism do not to catch a specific
need to have thyroid function tests diagnosis of goiter
Rampant practices – not recommended!
Fundamentals Paraclinical Diagnostic Procedures for Issues:
and Goiters • Inaccurate results
Generalities in Results of paraclinical diagnostic procedures are • Not knowing how
Medical not always 100% accurate (there are percentages to interpret results
Management of errors and non-conclusive results which must
of Goiter be recognized by the physician-clinicians).

The physician-clinicians must know how to

interpret and evaluate the results and correlate
them with their clinical diagnosis and decide:
ACCEPT / HOLD / REPEAT!
A lot of times, physicians accept results as final.
Rampant practice – has to be remedied for patients’ sake!
Fundamentals Paraclinical Diagnostic Procedures for
and Goiters
Generalities in • Using the fad, the popular one without comparative analysis
Medical (benefit, risk, cost and availability) of other options (usually with
Management no considerations for cost-effectiveness and patient preference)
of Goiter
Procedures Benefit (goal – to be Risk Cost (PhP) Availability
more definite on the
diagnosis)
Option1 accuracy 99% acceptable 4000 available
Option2 accuracy 90% acceptable 3000 available
Option3 accuracy 60% acceptable 1000 available
Fundamentals Paraclinical Diagnostic Procedures for Example of BRCA
and Goiters comparative analysis
Generalities in of paraclinical
Medical Procedures Benefit (goal – Risk Cost Availability diagnostic procedures
to be more
Management definite on the
diagnosis)
of Goiter
Ultrasound Indirect (2+) No pain  P
Thyroid Indirect (1+) No pain  PP
scan + Radiation
CT scan Indirect (3+) No pain PPPP
+ Radiation
Fundamentals Paraclinical Diagnostic Procedures for Example of BRCA
and Goiters comparative analysis
Generalities in of paraclinical
Procedures Benefit (goal – Risk Cost Availability
Medical to be more diagnostic procedures
definite on the
Management diagnosis)

of Goiter Biopsy Direct info (4+ Pain  PPP  

diagnostic
yield)
Ultrasound Indirect (2+) No pain  P
Thyroid Indirect (1+) No pain  PP  
scan + Radiation
CT scan Indirect (3+) No pain PPPP
+ Radiation
Fundamentals CONTENTS Summary
and • Clinical diagnosis of goiter Take Away
Generalities in • Paraclinical diagnostic procedures for
Medical goiters PART 2
Management
of Goiter
Fundamentals Be always in touch with reliable medical Take Away in
and information on fundamentals and relation to
Generalities in generalities in medical management of Patient
Medical goiter. Empowerment
Management
Knowledge is power; it gives power.
of Goiter
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of goiter.
 Health
Empowerment
Disorder
objective - for
Course–
laypeople to have an
Fundamentals
understanding of the
and
FUNDAMENTALS
Generalities in
and GENERALITIES in
Medical
the MEDICAL
Management
MANAGEMENT of
of Goiter –
GOITER – Part 2.
Part 2