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
