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THYROID GLAND

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THYROID GLAND MUST KNOW How to examine the neck and diagnose thyroid enlargement from other neck lumps. Clinical presentation of hypo and hyper Meaning and ... – PowerPoint PPT presentation

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Title: THYROID GLAND


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THYROID GLAND
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MUST KNOW
  • How to examine the neck and diagnose thyroid
    enlargement from other neck lumps.
  • Clinical presentation of hypo and hyper
  • Meaning and interpretaion of thyroid function
    tests.
  • How to investigate and manage a patient with STN
  • Clinical features ,dx and management of thyroid
    neoplasms

3
ANATOMY AND PHYSIOLOGY
  • WHY DOES THE YHROID MOVE ON SWALLOWING.

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MIDLINE SWELLINGS
  • Thyroid enlargement
  • Thyroglossal cyst
  • Dermoid cyst

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HYPOTHYROIDISM
  • FM 101
  • Due to commonly hashimotosTPO AND ANTI
    THYROGLOBULIN IS RAISED
  • Symptoms and signs
  • Exam
  • Lymphoma can develop on a back ground of
    autoimmune disease
  • TSH,T4 ,T3
  • TX Thyroxine

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hyperthyroidism
  • Causes include
  • Graves
  • Toxic multinodular goiter
  • Solitary toxic adenoma
  • Tx with thyroid uptake drugs
  • radioactive iodine
  • surgery


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MNG
  • Majority are non toxic
  • Some can become toxic ( plummers disease)
  • May extend retrosternally if large causing
    trachael deviation, compression and strider
  • O/E multinodular if there is dominant nodule then
    this should be investigated as the risk of
    malignancy in this nodule is about 10.

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  • TSH Low if toxic
  • FNA
  • US
  • X-ray of thoracic inlet
  • Tx Total for non-toxic if there is retrosternal
    ext., trachael comp or cosmotically unacceptable
  • If toxic - tx first the either total or
    radioactive iodine

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SOLITARY THYROID NODULE
  • 5 Of female population. But only 5 are
    malignant.
  • Causes 1- thyroid cyst
  • 2- degenerative thyroid nodule
  • 3- benign follicular adenoma
  • 4- differentiated thyroid ca

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  • History
  • Feature suggestive of malignancy
  • 1- previous irradiation (as a
    child)
  • 2- hoarsness
  • 3- family Hx (papillary)

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  • Investigation
  • Exclude solitary toxic adenoma (where TSH is
    suppressed) malignancy therefore TSH and FNA
    most important
  • If suspicious on FNA then for surgery as 30 are
    malignant
  • Ultrasound to distinguish solid from cystic or
    dominant nodule within MNG (50 STN)

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  • Isotope scan Increase uptake hot
  • Decreased uptake cold
  • Treatment

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Thyroid tumours
  • Benign thyroid tumours
  • Most are follicular adenomas
  • Papillary adenomas are rare
  • All papillary tumours should be considered
    malignant

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Follicular adenoma
  • Of all follicular lesions-80 benign and 20
    malignant
  • They are smooth and discrete lesions with
    glandular or acinar pattern
  • They are incapsulated usually 2-4 cm in diameter
  • Adenomas can not be differentiated from carcinoma
    on FNA cytology
  • Requires histological assessment of capsular
    invasion

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Malingnat thyroid tumours
  • Differentiated thyroid cancer accounts for 80 of
    thyroid neoplasms
  • Female Male ratio is 41
  • Usually presents as solitary thyroid nodule in
    young/middle age adult
  • Nodule more likely to be malignant in man or
    child
  • Papillary and follicular tumours are biologically
    very different

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Comparison of papillary and follicular tumours
  • Papillary tumours Follicular tumours
  • Multifocal Solitary
  • Unencpasulated Encapsulated
  • Lymphatic spread Haematogenous spread
  • Metastasize to Metastasize to lung.
  • regional bone and brain

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Papillary and mixed tumours
  • Accounts fro 70 Of Ca. thyroid.
  • 20-40 yrs
  • 50 tumours are less than 2cm diameter at
    presentation
  • Tumours less than 1cm diameter regarded as
    minimal or micropapillary lesoins
  • Psammoma bodies and orphan Annie nuclei are
    characteristic histologicalfeatures

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  • 30-50 are multicentric with simultaneous tumour
    in contralateral lobe
  • Early spread occurs to regional lymph nodes
  • Thyroid lobectomy adequate for minimal lesions
  • Total thyroidectomy is otherwise surgery of
    choice

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  • Many tumours are TSH dependent
  • TSH suppression with post-operative thyroxine
    appropriate
  • Thyroxine reduces recurrence and improves
    survival
  • 80 nodes have microscopic involvement
  • Role of prophylactic lymph node dissection at
    time of initial surgery unclear

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  • Lymph node dissection does not improve survival
  • Alternative is to sample the lymph nodes
  • If negative-no further surgery
  • If positive-modified neck dissection
  • Prognosis excellent (90 20 yrs)

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Follicular tumours
  • 40 50 yrs
  • Can not differentiate follicular adenoma and
    carcinoma on FNA cytology
  • Treatment of all follicular neoplasms is thyriod
    lobectomy with frozen section
  • If frozen section confirms carcinoma- total
    thyriodectomy
  • If frozen section confirms adenoma-No further
    surgery required
  • Total thyroidectomy allows detection of
    metastased using 123/Scanning during follow up
  • All patients require suppressive thyroxine
    therapy

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  • Follow up of thyroid carcinoma
  • Annual isotope scanning to detect asymptomatic
    recurrence
  • Treatment of such recurrence can still be
    curative
  • Serum thyroglobulin-increasing levels often first
    sign of recurrence

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Anaplastic carcinoma
  • Accounts for less than 5thyroid malignancies
  • Occurs in elderly and is usually an aggressive
    tumour
  • Local infilteration causes dysponea and dysphagia
  • Thyriodectomy seldom feasible
  • incision biopsy should be avoided as it often
    causes uncontrollable local spread
  • Radiotherapy and chemotherapy important modes of
    treatment
  • Death usually occurs within 6 months

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Thyroid lymphoma
  • Accounts for 2 of thyroid malignancies
  • Often arises with Hashimotos thyroiditis or
    non-Hodgkins B-cell lymphoma
  • Presents as a goitre in association with
    generalized lymphoma
  • Diagnosis can often be made by FNA cytology
  • Radiotherapy is treatment of choice
  • Prognosis is good often more than 85 5 yr
    survival

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Medullary carcinoma
  • 8
  • Para-follicular C-cells
  • 20 are familial
  • Can occur as part of MEN 2
  • 80 of cases are sporadic
  • Sporadic cases usually unilateral
  • 50 have lymph nodes at presentation
  • Familial cases often multifocal and bilateral
  • Tumours mets to nodes and via blood to bone,
    liver and lung
  • They produce calcitonin,
  • Total thyroidectomy is treatment of choice
  • Calcitonin can be used in follow up for the
    presence of metastatic disease

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THANK YOU
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