Brief introduction on disorders of thyroid gland

DISEASES OF THYROID GLAND

ANATOMY OF THYROID GLAND The gland as seen from the front is more

nearly the shape of a butterfly.

composed of 2 encapsulated lobes, one on either side of the trachea, connected by a thin isthmus.

The thyroid extending from the level of the fifth cervical vertebra down to the first thoracic. The gland varies from an H to a U shape, overlying the second to fourth tracheal rings.

TYPES OF THYROID DISORDERS

Hypofunction Hyperfunction Enlargements

1. Diffuse __ termed goiter regardless of functional status.

2. Nodule.

HISTORY

signs & symptom of hypo or hyperthyroidismpressure symptom as dysphagia ,dysphonia ,dyspnea &choking sensationChange in voicepresence of mass and its duration ,progression& pain.H/O exposure to radiation , diet , drugsFamily hx.

PHYSICAL EXAMINATION

Inspection palpation percussion Auscultation

CLASSIFICATION Simple goiter (euthyroid)

1. Diffuse hyperplastic: physiological Pubertal pregnancy

2. Multinodular goiter Toxic

1. Diffuse __ graves’ disease2. Multinodular3. Toxic adenoma

CLASSIFICATION- cont... Neoplastic 1- Bengin 2- Malignant Inflammatory 1- Autoimmune :

Chronic lymphocytic thyroditis Hashimoto’s disease

2- Granulomatous De quervain’s thyroditis

3- Fibrosing Riedel’s thyroiditis

4- Infective Acute (bacterial , viral thyroiditis ‘subacute thyroiditis’) Chronic ( tuberculous , syphilitic )

Other 1- amyloid.

INVESTIGATION chest and neck x-ray: - Show descend of thyroid gland to thorax and

mediastanal shifting in retrosternal goitre. iodine isotopes - By i.v injection of I131. Then, use gama rays to

show hot and cold nodules. CT scan - Show thyroid size and if there is compression to

trachea Endoscopic investigation:-bronchoscopy: show compression and infiltration of

trachea by tumer Biopsy: -fine needle aspiration biopsy.-true-cut biopsy.

TREATMENT OPTIONS Medical Treatment

Surgical Treatment

MEDICAL TREATMENT1. Antithyroid drugs

carbimazole propylthiouracil.

It use to treat hyperthyroidism.

2. Beta-adernergic blockers propranolol

it is control sympathetic over activty to control cardiovascular feature.

3. Radioactive iodine Taken orally in solution Given for 8-12 wks. Use for recurrent hyperthyroidism

SURGICAL TREATMENTIndications for operation Simple diffuse goiter: cosmetic reasons or pressure

symptoms

Nodular goiter: Additional reasons – may undergo toxicity, malignant change.

Solitary nodule: more chance of malignancy

Primary thyrotoxicosis: 1) Lack of response to medical treatment 2) Relapse after apparent cure 3) Toxicity of the drugs 4) Large size of the gland or retrosternal extension.

Toxic nodular goiter

SURGICAL TREATMENT (cont…)

Preoperative treatmentVocal cord assessment

Medical treatment with antithyroid drugs for cases of thyrotoxicosis , Lugol`s iodine 0.3 ml three times daily 10 days prior to surgery,Propranolol if needed

SURGICAL TREATMENT (cont…)

surgical proceduresSubtotal thyroidectomy

Hemithyroidectomy (lobectomy)

Total thyroidectomy

Excision of the isthmus

COMPLICATIONS OF THYROIDECTOMY

Haemorrhage Respiratory obstruction Recurrent laryngeal nerve

paralysis Hypoparathyroidism Hypothyroidism Recurrent thyrotoxicosis