Multinodular Goiter - Erler Zimmer 3D anatomy Series MP2101

This dissection model highlighting a Multinodular Goiter is part of the exclusive Monash 3D anatomy series, a comprehensive series of human dissections reproduced with ultra-high resolution color 3D printing.

Clinical presentation

A 53-year-old woman presented with abnormal neck swelling and a persistent cough. She complained of lethargy and weight gain in previous years. During the investigation, she died of unrelated cardiovascular disease several months later.

Pathology

The specimen, taken postmortem, included the base of the tongue, larynx, and trachea. It was cut in the coronal plane to allow a view of the internal laryngeal and tracheal anatomy. The thyroid gland is grossly enlarged, particularly the right lobe, which extends superiorly and inferiorly, well beyond its normal margins when viewed from the anterior aspect. The posterior cut surfaces show many hyper- and hypopigmented nodules, as well as cystic areas in both lobes. The base of the tongue, larynx, and trachea appear relatively normal.

Further information

Nodular goiter is often detected simply as a mass or swelling in the neck, but depending on the size and location of the growth it may produce symptoms of pressure on the trachea and esophagus. There may be difficulty breathing, dysphagia, coughing, and hoarseness. Recurrent laryngeal nerve palsy may occur due to an expanding goiter, but this is rare. Symptoms suggesting obstruction of the trachea may occur, including coughing, stridor, and shortness of breath. Occasionally, tenderness and a sudden increase in the size of the goiter occur due to cystic expansion or hemorrhage in a node[1].

Causes of goiter include autoimmune diseases (Hashimoto's thyroiditis, Grave's disease), formation of one or more thyroid nodules, and iodine deficiency. Goiter occurs when there is reduced thyroid hormone synthesis secondary to biosynthetic defects and/or iodine deficiency, leading to an increase in thyroid-stimulating hormone (TSH). This stimulates thyroid growth as a compensatory mechanism to overcome the reduced hormone synthesis. Elevated TSH is also thought to contribute to thyroid enlargement in the goiter form of Hashimoto's thyroiditis in combination with fibrosis secondary to the autoimmune process in this condition. In Grave's disease, goiter results mainly from stimulation by antibody of the TSH receptor[1].
Reference
1. Hughes et al. (2012) Goitre: Causes, investigation and management. Aust Family Physician, 41, 572-576.

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What advantages does the Monash University anatomical dissection collection offer over plastic models or plastinated human specimens?

• Each body replica has been carefully created from selected patient radiographic data or human cadaver specimens selected by a highly trained team of anatomists at the Monash University Center for Human Anatomy Education to illustrate a range of clinically important areas of anatomy with a quality and fidelity that cannot be achieved with conventional anatomical models-this is real anatomy, not stylized anatomy.
• Each body replica has been rigorously checked by a team of highly trained anatomists at the Center for Human Anatomy Education, Monash University, to ensure the anatomical accuracy of the final product.
• The body replicas are not real human tissue and therefore not subject to any barriers of transportation, import, or use in educational facilities that do not hold an anatomy license. The Monash 3D Anatomy dissection series avoids these and other ethical issues that are raised when dealing with plastinated human remains.