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Enlarged thyroid gland

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Dr. M. Malek May secret TSH autonomously. Without sensitivity to negative feedback. Thyroid function tests should be performed in all patients with goiter to exclude ... – PowerPoint PPT presentation

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Title: Enlarged thyroid gland


1
Enlarged thyroid gland
  • Dr. M. Malek

2
Enlarged thyroid
  • Diffusely enlarged (goiter)
  • Multinodular (Multinodular goiter)
  • Partially enlarged (single thyroid nodule)

3
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4
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  • Goiter refers to an enlarged thyroid gland
  • Biosynthetic defects
  • Iodine deficiency
  • Autoimmune disease
  • Nodular diseases
  • By different mechanisms

8
  • Biosynthesis effect iodine deficiency?
  • Reduced efficiency of thyroid hormone
    synthesis
  • ?Increase TSH
  • ?Stimulation of thyroid growth
  • (compensatory mechanism)

9
  • Enlargement of the thyroid suggests nothing about
    the function of thyroid.
  • Because can be
  • Hyper functioning
  • Normal functioning
  • Hypo functioning

10
Evaluation
  • Is undertaken principally to determine the
    thyroid function
  • presence or absence of malignancy.

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Thyroiditis
  • Fever, enlarged tender thyroid
  • Bacterial infection
  • TFTs are usually normal.

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Grave, s (diffuse toxic goiter)
  • Is the most common cause of goiter
    hyperthyroidism.
  • An autoimmune disease
  • Antibodies act to simulate thyroid function.
  • Exophthalmos, burning, itching, pretibial
    dermopathy.

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Trophoblastic tumors
  • Rarely can simulate goiter hyperthyroidism.
  • HCG has some biologic cross-activity with TSH.

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Jadbasedow phenomenon
  • Hyperthyroidism induced by iodine
    supplementation.

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De quervain,s thyroiditis
  • Subacute granulomatous thyroiditis
  • Painful enlargement
  • Fever, malaise, chills
  • F/M 3
  • Unknown cause but usually follows a viral
    infection by several weeks

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Subacute lymphocytic thyroiditis
  • A painless thyroiditis, hyperthyroidism
    enlargement
  • Unknown cause probably autoimmune

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Hashimoto
  • Chronic lymohocytic thyroiditis
  • Most common thyroid disorders in USA
  • Painless palpable goiter
  • Usually initially euthyroid
  • But ultimately almost always hypothyroid
  • Hyperthyroidism must be distinguished from Graves

26
Hashimoto
  • Dx Antimicrosomal Abs In approximately 95
  • Antithyroglobolin Abs in 50 to 60
  • Radioactive iodine uptake may be normal, low or
    increased

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Reidel ,s thyroiditis
  • A rare disorders
  • A firm, enlarged gland
  • Sclerosing fibrous infiltration
  • Hypothyroidism

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Endemic goiter
  • In a large fraction of the population.
  • Most commonly a result of iodine deficiency.
  • Now is very rare in the USA owing to iodinization
    of salt.

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Sporadic goiter
  • An enzymatic defect.
  • Leading to low thyroid hormone levels.
  • Elevated level of TSH.

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Pituarity adenoma
  • May secret TSH autonomously.
  • Without sensitivity to negative feedback.

35
TFT
  • Thyroid function tests should be performed in all
    patients with goiter to exclude thyrotoxicosis or
    hypothyroidism.

36
Thyroid scanning
  • Thyroid scanning is not generally necessary but
    will reveal increased uptake in iodine deficiency
    and most cases of dyshormonogenesis.

37
Ultrasound
  • Ultrasound is not generally indicated in the
    evaluation of diffuse goiter unless
  • a nodule is palpable on physical examination.
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