February 3, 2024

1400H - 1500H
Via Zoom

Empowerment
objective - for
GOITER laypeople to have a
AWARENESS basic understanding
of THYROID GOITER
in their health
management.
 February 3, 2024
1400H - 1500H
Via Zoom
Welcome all!

MUTE yourself but always

show your video picture.
Empowerment
Sign in your name, FB
objective - for account, or email address in
GOITER laypeople to have a the Chat Box! Include names
of companions attending.
AWARENESS basic understanding
of THYROID GOITER Use the Chat Box to ask
questions and make
in their health comments while the PEP TALK
is on.
management.
There will be group pictures
at start and end of PEP TALK –
show your face in video.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:

Empowerment FEEDBACK TO THIS

objective - for PEP TALK!
GOITER laypeople to have a Pls. type in your
AWARENESS basic understanding feedback in the chat
of THYROID GOITER box during the open
in their health forum and before we
management. adjourn!

Thank you!
 LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
Empowerment START PEP TALK
objective - for PROPER IN 2
GOITER laypeople to have a MINUTES!
AWARENESS basic understanding
Pls. turn on your
of THYROID GOITER video!
in their health Show your face!
management.
 ROJoson PEP Talk
Empowerment
objective - for I have a Patient
Empowerment
GOITER laypeople to have a
Program in which I
AWARENESS basic understanding like to empower the
of THYROID GOITER lay people or
in their health patients to take
management. control in the
management of
their health.
I started the PEP Talk
on May 15, 2021
during the COVID19
Pandemic. 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 depending on
our enthusiasm,
discipline and
perseverance.
 My PEP TALK today is
entitled:
GOITER
Empowerment AWARENESS
objective - for
GOITER laypeople to have a
AWARENESS basic understanding This is my
of THYROID GOITER contribution to
in their health the PH DOH
management. Goiter Awareness
Week (4th week of
January).
 Contents Disclaimer:

GOITER • What is a goiter?

• ROJoson PEP Talk
What are the different types of goiter?
AWARENESS • contains ROJoson’s
What are the causes of goiter?
• Thoughts,
How to recognize goiter and its different
Perceptions,
types?
• Opinions and
What paraclinical diagnostic tests are usually
Recommendations
done for goiter?
• (TPORs) culled from
What are the usual treatment for the different
experiences of
types of goiter?
• ROJoson and other
What are the post-treatment management for
professionals.
goiter?
 What is a goiter?
GOITER
AWARENESS
 What is a goiter?
GOITER Loosely speaking, goiter refers to
AWARENESS something wrong with the thyroid gland, a
butterfly-shaped organ located in the base
and central part of the neck.

Goiter is defined as any disorder in the

thyroid gland.
 What is a goiter?
GOITER The thyroid gland is a vital organ (vital organ –
AWARENESS one that is needed to survive) that regulates
metabolism, growth and development of the
human body. The thyroid gland makes, releases,
and controls thyroid hormones that control
metabolism. Metabolism is a process where the
food taken into body is transformed into energy.
This energy is used throughout the entire body to
keep many of the body's systems working
correctly.
 What is a goiter?
GOITER Goiter is defined as any disorder in the
AWARENESS thyroid gland.
 What are the different types of goiter?
GOITER
AWARENESS
 What are the different types of goiter?
GOITER Goiter can be classified into several categories:
AWARENESS  By clinical presentation (diffuse or nodular
goiter; euthyroidism, hyperthyroidism,
hypothyroidism)
 By general categories of diseases (malignant vs
non-malignant disorders; hyperthyroidism vs
hypothyroidism)
 By names of specific disease
 What are the different types of goiter?
GOITER Clinical Classification of Goiter:
AWARENESS
• Diffuse toxic goiter (with diffuse enlargement
with hyperthyroidism)
• Diffuse non-toxic goiter (with diffuse
enlargement without hyperthyroidism – may
be euthyroidism or hypothyroidism)
• Nodular toxic goiter (with nodule/s with
hyperthyroidism)
• Nodular non-toxic goiter (with nodule/s
without hyperthyroidism may be euthyroidism
or hypothyroidism)
 What are the different types of goiter?
GOITER Definition of diffuse enlargement – the major
AWARENESS lobes of the thyroid glands such as the right and
left lobes are almost symmetrically enlarged or
increase in size and without nodule/s
 What are the different types of goiter?
GOITER Definition of nodules – presence of nodule /
AWARENESS nodules or lump/lumps / dominant mass/es
 What are the different types of goiter?
GOITER Diffuse Goiter vs Nodular Goiter
AWARENESS
 What are the different types of goiter?
Diffuse enlargement – Hyperthyroidism, hypothyroidism or
GOITER euthyroidism (depending on the associated symptoms and
AWARENESS signs)
Nodule formation – Malignant vs non-malignant disorders
 What are the different types of goiter?
GOITER Common diseases that I usually diagnose which
AWARENESS can be recognized clinically and relatively
common in the community:

• Hyperthyroidism (Graves’ Disease)

• Hyperthyroidism (unspecified)
• Hypothyroidism

• Acute thyroiditis
• Chronic thyroiditis
 What are the different types of goiter?
GOITER Common diseases that I usually diagnose which
AWARENESS can be recognized clinically and relatively
common in the community:

Malignant nodules or thyroid cancers:

• Papillary carcinoma
• Follicular carcinoma
• Anaplastic carcinoma
• Medullary carcinoma
 What are the different types of goiter?
GOITER Common diseases that I usually diagnose which
AWARENESS can be recognized clinically and relatively
common in the community:

Non-malignant nodules or conditions:

• Colloid cyst
• Colloid adenomatous nodule
• Multiple colloid adenomatous goiter
• *Diffuse colloid adenomatous goiter
 What are the causes of goiter?
GOITER
AWARENESS
 What are the causes of goiter?
GOITER In general, risk factors include:
AWARENESS • Genetic predisposition
• Environmental influence – like lack of
iodine intake; excessive exposure to
radiation to the neck; stress

NOTE: A lot of goiters have NO definite

known cause.
 What are the causes of goiter?
GOITER More specific causes for specific diseases:
AWARENESS
• Iodine deficiency goiter – lack of iodine intake
• Colloid adenomatous goiter – physiologic and
degenerative condition
• Cancer – genetic mutation with genetic
predisposition and radiation exposure
• Chronic thyroiditis – autoimmune disease
• Acute thyroiditis – infection
• Hyperthyroidism – autoimmune disease
• Hypothyroidism – iodine deficiency, physiologic
 What are the causes of goiter?
GOITER Except for iodine deficiency goiter due to lack of
AWARENESS iodine intake which can be prevented, for the
other diseases, one, nobody can predict when
one is going to have a thyroid disease and two,
the causes are realistically difficult to identify and
to control.
Healthy lifestyle with adequate iodine intake is
the best bet against thyroid diseases. However,
there is a percentage that one cannot prevent a
thyroid disease from occurring even with a
healthy lifestyle.
 How to recognize goiter and its different
types?
GOITER
AWARENESS
 How to recognize goiter and its different
types?
GOITER
AWARENESS • Lump/s on the front, base and central
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
 How to recognize goiter and its different
types?
GOITER
AWARENESS Persistent fatigue

A cue or alert-signal for

HYPOTHYROIDISM
 How to recognize goiter and its different
types?
GOITER
AWARENESS • Palpitation
• Sudden weight loss

Cues or alert-signals for

HYPERTHYROIDISM
 How to recognize goiter and its different
types?
GOITER
AWARENESS • Lump/s on the front, base and central
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)
 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS
 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Common instrumental and laboratory diagnostic
procedures that can be used after the clinical
diagnosis of goiter:
• Thyroid function tests – FT3, FT4, TSH
• Imaging procedures – ultrasound, thyroid scan,
CT Scan, MRI, PET Scan
• Needle aspiration ± biopsy
 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Thyroid function tests – FT3, FT4, TSH
to check level of thyroid hormones in the blood –
euthyroid; hyperthyroid; hypothyroid.
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
 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Thyroid function tests
Interpretations:
• Normal FT4 and normal TSH – euthyroidism
• Elevated FT4 and below normal TSH –
hyperthyroidism
• Below normal FT4 and elevated TSH -
hypothyroidism
 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Imaging procedures – ultrasound, thyroid scan, CT
Scan, MRI, PET Scan

Indication:
When needed to evaluate the structure
(ultrasound, CT Scan, MRI) and at times, function
of the thyroid gland (thyroid scan and PET Scan)

Choose the most cost-effective ones.

 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Imaging procedures – ultrasound, thyroid scan, CT
Scan, MRI, PET Scan

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.

 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Imaging procedures – ultrasound, thyroid scan, CT
Scan, MRI, PET Scan

Indication:
Thyroid scan using a radioactive isotope is used
primarily to determine whether there is nodule
that is hyperfunctioning or not.

Choose the most cost-effective ones.

 What paraclinical diagnostic tests are
usually done for goiter?
GOITER
AWARENESS Needle aspiration ± biopsy

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)
 What are the usual treatment for the
different types of goiter?
GOITER
AWARENESS
 What are the usual treatment for the
different types of goiter?
GOITER
AWARENESS
• Watchful waiting
• Medications
• Operations
• RAI therapy
• Chemotherapy
 Treatment for Non-Cancer Goiters Goals of treatment

GOITER Goiters with functional disorders Curative vs control

AWARENESS • Hyperthyroidism
• Some don’t recur
• Hypothyroidism after treatment!
• Some recur!
Goiters with non-functional disorders and benign
Only time will tell!
conditions
• Colloid adenomatous goiters NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
 Treatment for HYPOTHYROIDISM Goals of treatment

GOITER Medical therapy (NO OPERATION as this will Curative vs control

AWARENESS aggravate the hypothyroidism)
• Some don’t recur
after treatment!
Replacement therapy – thyroid hormones, usually • Some recur!
levothyroxine – usually lifetime!
Only time will tell!

NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
 Treatment for HYPERTHYROIDISM Goals of treatment

GOITER 3 options for goiters that are small to moderate in Curative vs control
AWARENESS size:
• Some don’t recur
• Medical therapy with anti-thyroid drugs
after treatment!
• Operative therapy • Some recur!
• Radioactive iodine therapy
Only time will tell!

For huge-size goiters, operative therapy is NO GUARANTEE FOR

recommended! CURE!
May need lifetime
maintenance meds!
 Treatment for COLLOID ADENOMATOUS
Options:
GOITERS
GOITER • Monitor without
AWARENESS 4 categories: meds
• Meds (levothyroxine)
• Diffuse colloid adenomatous goiter
• Operation
• Colloid cyst
• Solitary colloid adenomatous goiter or nodule • Operation is
recommended for
• Multiple colloid adenomatous goiter
huge-size goiter.
• Small to moderate
ones, no operation
(monitor without
meds or with meds)
 Treatment for Non-Cancer Goiters Goals of treatment

GOITER Goiters with functional disorders Curative vs control

AWARENESS • Hyperthyroidism
SURVEILLANCE OR • Some don’t recur
• Hypothyroidism MONITORING NEEDED – LIFE after treatment!
TIME! • Some recur!
Goiters with non-functional disorders and benign
Only time will tell!
conditions
• Colloid adenomatous goiters NO GUARANTEE FOR
CURE!
May need lifetime
maintenance meds!
 Treatment for Thyroid Cancers
GOITER 4 common types of thyroid cancers
AWARENESS • Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma
• Anaplastic carcinoma
 Treatment for Thyroid Cancers
GOITER
AWARENESS
The usual goals of thyroid cancer treatment
include
• eradicating known tumors / cancers entirely,
preventing the recurrence or spread of the Curative goal
primary cancer, and
• relieving symptoms if all reasonable curative Palliative goal
approaches have been exhausted.
 Treatment for Thyroid Cancers
GOITER 4 common types of thyroid cancers
AWARENESS • Papillary carcinoma
For curative goal:
• Follicular carcinoma • Primary treatment modality: OPERATION
• Medullary carcinoma • May be followed by radioactive iodine
therapy
• Anaplastic carcinoma • May be followed by medical suppressive
therapy using levothyroxine

For palliative goal:

• Chemotherapy
• Radiation therapy
 Treatment for Thyroid Cancers
GOITER
AWARENESS
4 common types of thyroid cancers
• Papillary carcinoma
• Follicular carcinoma
• Medullary carcinoma OPERATIONS:
• Anaplastic carcinoma • Thyroidectomy (subtotal / total)
• Neck dissection (different kinds)
 What are the post-treatment
management?
GOITER
AWARENESS
 What are the post-treatment
management?
GOITER
AWARENESS After treatment for any type of goiter,
• Non-cancer goiters
• Cancer goiters (particularly)
there must be surveillance or follow-up or check-
up – usually lifetime – for recurrence.

Early detection of recurrence  early treatment

 better outcome!
 What are the post-treatment
management?
GOITER
AWARENESS Patients may be taking maintenance meds for
control of disease – may be lifetime!

Patients are advised to have a healthy lifestyle to

promote health restoration and maintenance.

Except for ANAPLASTIC THYROID CA (fortunately

rare) and advanced cancers, the rest can still have
a long life after treatment.
 Contents Summary
• What is a goiter? Take Away
GOITER
• What are the different types of goiter?
AWARENESS • What are the causes of goiter?
• How to recognize goiter and its different
types?
• What paraclinical diagnostic tests are usually
done for goiter?
• What are the usual treatment for the different
types of goiter?
• What are the post-treatment management for
goiter?
 Be always in touch with reliable medical Take Away in
information on THYROID GOITER. relation to
GOITER
AWARENESS Knowledge is power; it gives power. Patient
Empowerment
Use the 4Ks of Patient Empowerment:
Kaalaman, Kakayanan, Karapatan and
Kapangyarihan
to gain greater control over decisions in
medical management of THYROID GOITER.
 Empowerment
objective - for
GOITER laypeople to have a
AWARENESS basic understanding
of THYROID GOITER
in their health
management.
Reminder after the PEP
Talk:

Take the Online Learning

cum Evaluation Test
Exercise (OLETE) for
mastery of learning and
have a perfect score to get
a Certificate.

Link is in Chat Box.

Reminder:
50 OLETE Certificates = 1
Voucher for ROJoson
Medical Consultation
either Face-to-Face or
Telemedical.
 ROJOSON’S REQUEST:

Empowerment FEEDBACK TO THIS

objective - for PEP TALK!
GOITER laypeople to have a Pls. type in your
AWARENESS basic understanding feedback in the chat
of THYROID GOITER box during the open
in their health forum and before we
management. adjourn!

Thank you!
 LET’S NOW HAVE A
GROUP PICTURE
TAKING BEFORE WE
Empowerment START Q&A AND
objective - for INTERACTIONS!
GOITER laypeople to have a
AWARENESS basic understanding Pls. turn on your
of THYROID GOITER video!
Show your face!
in their health
management.