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Thyroid and parathyroid diseases

Thyroid and parathyroid diseases. Define the anatomy of the Neck. 1. Anterior triangle 2. Posterior triangle. Surface landmark of the neck. Thyroid cartilage Cricoid cartilage Anatomy of thyroid Organs specific found in different triangle. Anatomy. Embryology Anatomy.

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Thyroid and parathyroid diseases

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  1. Thyroid and parathyroid diseases

  2. Define the anatomy of the Neck • 1. Anterior triangle • 2. Posterior triangle

  3. Surface landmark of the neck • Thyroid cartilage • Cricoid cartilage • Anatomy of thyroid • Organs specific found in different triangle

  4. Anatomy • Embryology • Anatomy

  5. Steps in thyroid examination • Inspect the neck • Ask the patient to swallow • Palpate from the back, flex the neck slightly • Palpate both lobes and the rest of the neck for LNs • Additional tests • General and peripheral signs • Eye signs of thyrotoxicosis

  6. The gland Solitary nodule More than one nodules (nodular) Diffusely enlarged Activity of gland Hypersecretion Euthyroid hyposecretion Diagnosis of thyroid nodule

  7. Single palpable nodule • Dominant nodule of MNG • Solitary nodule • Thyroid cyst • Benign adenoma • Thyroid carcinoma • Single palpable gland (Hashimoto’s thyroiditis)

  8. More than one nodule • MNG • Anaplastic Ca

  9. Diffusely enlarged • Grave’s disease • Slight to moderate enlargment • Soft, smooth with a bruit • Colloid goitre • Moderate to gross • Bosselated, no bruit • Thyroditis • Small to moderate • Hard and tender

  10. Thyroglossal Cyst • Anterior triangle of Neck • Development of thyroid gland • Tongue tug sign • transillumnate

  11. Diagnosis of swelling of the neck • Mulitple lumps usually LNs • A single lump • Anterior triangle • LN, carotid body, cold abscess branchial cyst • Thyroid, thyroiglossal cyst • Posterior triangle • LN, cystic hygroma, pharyngeal pouch, subclavian aneurysm

  12. Thyroidectomy • Conventional approach • Minimally invasive approach

  13. Thyroidectomy • Subtotal • Near total • Lobectomy • Isthmectomy • Total

  14. Complications • Haemorrhage • Respiratory obstruction • Recurrent laryngeal nerve paralysis • Thyroid insufficiency • Parathyroid insufficiency • Thyrotoxic crisis • Keloid scar • Stitch granuloma

  15. Goiter=enlargement of thyroid • Grade 0: no goiter • Grade 1: palpable but not visible • Grade 2: Visible on neutral position • Grade 3: goiter visible at a distance

  16. Approach to thyroid nodule

  17. Hypoparathyroidism • Parathyroid tetany due to hypcalcaemia • Usually after thyroidectomy rarely autoimmune disease • Transient vs permanent • Tingling and numbness of face • Cramps in hand and feet • Obsterician’s hand • Chvostek’s sign; Trousseau’s sign

  18. Hyperparathyoridism • Primary • Secondary • Teritary

  19. Primary hyperparathyoridism • Pentad of symptoms • Painful bones • Kidney stones • Abdominal groans • Psychic moans • Fatigue overtones

  20. Preoperative localization • USG • Sestamibi scanning • CT scan • MRI

  21. Indications for surgery • Symptoms • Asymptomatic • Ca > 1 mg/dL above normal range • 24-hr urine ca >400mg/day • 30% decrease in CrCL • Bone density greater than 2.5 SD below peak bone mass • Age <50 • Medical surveillance not possible

  22. Parathyroidectomy • Bilateral neck exploration • Unilateral neck exploration • Focused parathyroidectomy

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