Overview-
1. Dyspnea
2. Dysphonia
3. Dysphagia
4. Tracheal Deviation
5. Retrosternal goiter
6. Pemberton’s Sign
Thyroid gland present in neck region and it have two lobe (Right and left) and both lobe are connect with isthmus.
Thyroid gland present in front of the tracha and it secret three hormone
1. Thyroxine or tetra iodo thyronine (T4)
2. Tri iodo thyronine (T3)
3. Calcitonin– It is secret by parafollicular cells.
Enlargement of the thyroid gland is called goiter.
Iodine deficiency is the most common cause of goiter.
Dyspnea-
Goiter patient have difficulty in breathing because the enlarged thyroid gland compress the windpipe.
Dysphonia-
Also called hoarseness of voice.
This is due to the paralysis of vocal cord / vocalis muscle (supplied by the recurrent laryngeal nerve)
Recurrent laryngeal nerve supply to the all muscles of larynx except cricopharyngeal muscle.
Recurrent laryngeal nerve (RLN) present in tracheo esophageal groove and it is compress by the goiter and cause dysphonia.
Dysphagia-
In the case of goiter, the patient says that I am having trouble in swallowing food.
Dysphagia is due to esophagus is compress by the enlarge thyroid gland.
Tracheal Deviation-
Enlarge thyroid gland (goiter) push the trachea toward right and left side.
It is also see in pneumothorax, atelectasis, and any neck or mediastinum mass.
Retrosternal goiter
When the enlarge thyroid gland reach behind the sternum (mediastinum) it is called retrosternal goiter.
Retrosternal goiter compress the superior vena cava (SVC) and cause venous congestion (blood accumulate into vein)
Symptoms-
Dyspnea
Dysphagia
Venous congestion (due to compression of neck veins and superior vena cava)
Sign- Pemberton’s Sign
Pemberton’s Sign-
This is used in the physical examination of the patient.
Ask the patient to raise their both hands over the shoulder up to both arm should be touch his ear.
In the case of superior vena cava obstruction and retrosternal goiter we see facial congestion on the patient face.
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