Thyroid appearance of cells is viewed to determine whether they resemble normal or cancerous cells. There can be many nodules, which is termed a multinodular goitre, and this can sometimes be a toxic multinodular goitre. An enlarged thyroid gland is called a goitre. Goitres are present in some form in about 5% of people, and are the result of a large number of causes, including iodine deficiency, autoimmune disease (both Grave's disease and Hashimoto's thyroiditis), infection, inflammation, and infltrative disease such as sarcoidosis and amyloidosis. Sometimes no cause can be found, a state called "simple goitre". Some forms of goitre are
Vitamin A deficiency conjunctiva, known as Bitot's spots, can be seen. ; Imtiaz's sign is the earliest ocular sign of VAD. Conjunctival epithelial defects occur around lateral aspect of the limbus in the subclinical stage of VAD. These conjunctival epithelial defects are not visible on a biomicroscope, but they take up black stain and become readily visible after instillation of kajal (surma); this is called "Imtiaz's sign". VAD can also lead to impaired immune function, cancer, and birth defects. Vitamin A deficiency is one of several hypovitaminoses implicated in follicular hyperkeratosis. Night blindness is the difficulty for the eyes to adjust to dim