Xavier University Ateneo de Cagayan

College of Nursing
S.Y. 2016 2017

A Concept Map of Nodular Goiter

Submitted to:
Maam Jesusa Gabule, RN MAN
Clinical Instructor

Submitted by:

Castro, Shaira
Paderanga, Ma. Elyza Allene N.

BSN 3 NB
September 16, 2016

A. DISEASE CONDITION
The thyroid gland is an important organ of the endocrine system. It is located at the
front of the neck just above where your collarbones meet. The gland makes the
hormones that control the way every cell in the body uses energy. This process is
called metabolism.
(Brunner & Suddarths) Some thyroid glands are nodular because of areas of
hyperplasia (overgrowth). no symptoms may arise as a result of this condition, but
not uncommonly these nodules slowly increase in size with some descending into
the thorax, where they cause local pressure symptoms. Some nodules become
malignant, and some are associated with a hyperthyroid state. Therefore, the patient
with many thyroid nodules may eventually require surgery.
Nodular goiter can refer to:
Toxic nodular goitre - (or Plummer syndrome) is a condition that can occur when
a hyper-functioning nodule develops within a longstanding goiter. This results in
hyperthyroidism, without the ophthalmologic effects seen in Grave's disease.
These toxic multi or uni-nodular goiters are most common in women over the
age of 60.
Toxic multinodular goitre
Nontoxic nodular goiter - is an enlarged thyroid without hyperthyroidism. It is
often present for years before toxic nodular goiter occurs. In the United States it
is the most common cause of a large thyroid affecting between 3 and 5% of the
population.

B. PREDISPOSING/PRECIPITATING FACTORS
PREDISPOSING FACTORS

 Sex
The female-to-male ratio is 4:1. In the Wickham study, 26% of women had a goiter,
compared to 7% of men. Thyroid nodules are less frequent in men than in women,
but when found, they are more likely to be malignant.
Age
The frequency of goiters decreases with advancing age. The decrease in frequency
differs from the incidence of thyroid nodules, which increases with advancing age.
Familial Goiter
Genetic marker (TG, MNG-I)
Geographic Areas
PRECIPITATING FACTORS
Iodine deficiency is the most common cause of goiter. The body needs iodine to
produce thyroid hormone. If you do not have enough iodine in your diet, the
thyroid gets larger to try and capture all the iodine it can, so it can make the right
amount of thyroid hormone. So, a goiter can be a sign the thyroid is not able to
make enough thyroid hormone. The use of iodized salt in the United States
prevents a lack of iodine in the diet.
Overgrowth of normal thyroid tissue. Why this occurs isn't clear, but such a
growth which is sometimes referred to as a thyroid adenoma is
noncancerous and isn't considered serious unless it causes bothersome
symptoms

from

its

size.

Some

thyroid

adenomas

(autonomous

or

hyperfunctioning thyroid nodules) produce thyroid hormones outside of your

pituitary gland's normal regulatory influence, leading to an overproduction of
thyroid hormones (hyperthyroidism).
Thyroid cyst. Fluid-filled cavities (cysts) in the thyroid most commonly result from
degenerating thyroid adenomas. Often, solid components are mixed with fluid in
thyroid cysts. Cysts are usually benign, but they occasionally contain malignant
solid components.
Chronic inflammation of the thyroid (thyroiditis).Hashimoto's disease, a thyroid
disorder, can cause thyroid inflammation resulting in nodular enlargement. This
often is associated with reduced thyroid gland activity (hypothyroidism).
Multinodular goiter. "Goiter" is a term used to describe any enlargement of the

thyroid gland, which can be caused by iodine deficiency or a thyroid disorder. A

multinodular goiter contains multiple distinct nodules within the goiter, but its
cause is less clear.
Thyroid cancer. Although the chances that a nodule is malignant are small,
you're at higher risk if you have a family history of thyroid or other endocrine
cancers, are younger than 30 or older than 60, are a man, or have a history of
radiation exposure, particularly to the head and neck. A nodule that is large and
hard or causes pain or discomfort is more worrisome in terms of malignancy.

C. CLINICAL MANIFESTATIONS

D. DIAGNOSTIC STUDIES (relevance to the condition)

The health care provider will do a physical exam. This involves feeling your neck as
you swallow. Swelling in the area of the thyroid may be felt.
If you have a very large goiter, you may have pressure on your neck veins. As a
result, when the provider asks you to raise your arms above your head, you may feel
dizzy.
Blood tests may be ordered to measure thyroid function:
Free thyroxine (T4)
Thyroid stimulating hormone (TSH)
Tests to look for abnormal and possibly cancerous areas in the thyroid gland
include:
Thyroid scan and uptake
Ultrasound of the thyroid
If nodules are found on an ultrasound, a biopsy may be needed to check for
thyroid cancer.
E. MEDICAL AND SURGICAL MANAGEMENT
MEDICAL MANAGEMENT
SURGICAL MANAGEMENT

F. NURSING DIAGNOSIS & INTERVENTION

G. BIBLIOGRAPHY:
http://emedicine.medscape.com/article/120034-overview#a6
https://medlineplus.gov/ency/article/000317.htm