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Thyroid Disease

Thyroid Disease. M. Alhashash MD. Anatomy . Over Trachea Two Lobes connected together by an isthmus 15 to 20 g. Sites of normal & ectopic thyroid tissue. FUNCTIONAL UNIT IS THE FOLLICLE. Arterial supply . Superior thyroid artery Inferior thyroid artery Thyroida ima artery

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Thyroid Disease

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  1. Thyroid Disease M. Alhashash MD

  2. Anatomy • Over Trachea • Two Lobes connected together by an isthmus • 15 to 20 g

  3. Sites of normal & ectopic thyroid tissue

  4. FUNCTIONAL UNIT IS THE FOLLICLE

  5. Arterial supply • Superior thyroid artery • Inferior thyroid artery • Thyroidaima artery • Anastomosis with esophagus and trachea

  6. Venous drainage • Superior thyroid vein IJV • Middle thyroid vein IJV • Inferior thyroid vein innom. V.

  7. Lymphatics • Direct : Upper and lower deep cervical LN • Indirect : • Pretracheal LN • Paratracheal LN • Inferior and superior thyroid veins LN

  8. Nerve supply • Sympathetic (blood supply) • Parasympathetic (RLN)

  9. Thyroid Regulation

  10. Normal Physiology • TSH stimulates secretion of T4 and T3 from thyroid • Most serum T3 produced by deiodination of T4 • Think of T3 as active hormone and T4 as prohormone • Only small fraction total T4 and total T3 is unbound – therefore free and active

  11. TFTs • TSH is the screening test of choice for thyroid function (nml 0.3-5mU/L) • T4 • T3 • Antithyroglobulin (TSAb)

  12. Evaluation of Thyroid Diseases • Clinical history and physical examination • Serum T3 & T4, TSH determination • Thyroid scan (RAIU) • Thyroid ultrasound • Plain x-ray, CT scan / MRI • FNAC • Sleeping pulse & laryngoscope.

  13. THYROID GLAND DISORDERS • CONGENITAL • SIMPLE • Diffuse : 1-physiological 2- colloid • Nodular 1-multinodular 2- solitary • Toxic • Primary • Secondary • Neoplastic • Benign • Malignant. • Inflammatory

  14. Answer the following questions:(time allowed 5 minutes) • Enumerate types of shock: • -------------- • --------------- • ---------------- • ---------------- • Define: • Epistaxis: is……………………………………….. • Hemoptesis: is…………………………………... Good luck.

  15. Congenital anomalies 1 • Agenesis------------ L-troxine • Ectopic (along the line of descent) • Lingual ----------at the foramen caecum , may be the only thyroid tissue, causes yellow swelling, dysphagia and bleeding . Treatment : L-troxine , excision and reimblantation. • Median ectopic ---------in the upper 2/3 of neck , can be the only thyroid tissue . Treatment excision and reimplantation. • Aberrant(away from the line of descent) • Median (larynx, trachea, intrathoracic) • Lateral(obsolete term, in LNs= metastasis)

  16. Sites of normal & ectopic thyroid tissue

  17. Congenital anomalies 2 • Anomalies of thyroglosal tract • Thyroglossal cyst • Thyroglossal fistula(sinus)

  18. Simple goiter • Def : non inflammatory , non toxic, non neoplastic enlargement of thyroid gland. • Etiology : ch. Decrease of thyroid hormone or rarely pituitary adenoma. • Decrease I2 • Decrease synthesis of hormones • Antithyroid drugs • Goitrogenic substances (cabbage, cauliflower)

  19. Stress leads to dec. T3 & T4increase TSH physiological goiter. • Stress over --> normal gland • Prolonged stress exhaustion of the gland diffuse colloid goiter and after time nodular colloid goiter. • Stress repeated fibrosis simple multinodulargoiter.

  20. Treatment of simple goitre. • Physiological L-troxine + I2 -> good response. • Colloid rarely respond • Nodular goiter never respond to medical treatment. • Subtotal or total thyroidectomy followed by L-troxine.

  21. Complication of simple goiter. • Haemorrhage • Secondary thyrotoxicosis • Malignant transformation(size, pain, ill defined, fixed, hard, LNs, vessel & nerves) • Calcification • Cyst formation • Retrosternal extension • Infection • Pressure (trachea, carotid v. , retrosternal)

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