Documente Academic
Documente Profesional
Documente Cultură
KCH
“THYROID”
Wisdom’s Lecture Notes
• Anatomy
• Embryology
• Histology
• physiology
• Clinical features
• Thyroid cancers
• Investigations
• Management
• Complications
Thyroid Gland
• Location
– Anterior triangle of the neck
• Size
– 5X3X2
– 25gm
• Shape- H shape, 2 lateral lobes & Isthmus.
• Pyramidal lobe in few individuals
20-3
Lobes of the thyroid
gland
1. Pyramidal lobe
2. Right lobe
3. Isthmus
4. Left lobe
• Anteriorly:
Skin
Subcutaneous
Platysma
Strap muscles
Thyrohyoid
Omohyoid
Mnemonic:
Sternohyoid
sternothyroid TOSS
Pre-tracheal fascia
BORDERS
• Posterior aspect:
Trachea and esophagus
• Lateral Aspect:
Carotid sheath: Internal Jugular Vein, Vagus Neive and
the Internal Carotid Artery
• Mneumonic is JVC
EMBROLOGY
Copyright © 2003 Pearson Education, Inc. publishing as Benjamin Cummings Slide 16.32a
Thyroid Follicle
Thyroid
Colloid
C cells
PHYSIOLOGY
• Normal levels
• T3: 1.5- 3.5 nmol/l
• T4: 55-150 nmol/l
• TSH: 0.5-5 iu/ml
Functions in general
• Cold intolerance,
• decreased sweating.
• Hoarseness.
• Weight increase,
• constipation.
• Slow cerebration,
• tiredness.
• Muscle pains.
THYROID CANCER-TYPES
• Rubbery, encapsulated
• Male/female ration 1:3
• Hematogenous spread, more aggressive than
papillary adenocarcinoma
• Good uptake I^131
• 10-year survival rate is 85%
• FNA can’t make a diagnosis
• Bone metastasis is the common distance spread
Follicular cancer:
• 5%
• Female male; 1.5:1
• Associated with MEN type II;
• Histologically -Amyloid (aMyloid Medullary)
• Secretes Calcitonin (tumor marker)
• Lymphatic and hematogenous distant metastasis
• Poor uptake I^131
4. HÜRTHLE CELL THYROID CANCER
• Undifferentiated carcinoma
• 2%
• Women >men
• Histologically Giant cells, spindle cells
• Very poor uptake I^131
• Very aggressive
• Poor prognosis because most patients are at stage
IV at presentation (3% alive at 5 years)
INVESTIGATIONS
Diagnostic
Indications;
• Thyroid malignancies
• Symptomatic thyroid mass
• Patient with refractory medically graves disease or
hyperthyroidism
Contraindication;
• Uncontrolled hyperthyroidism
• Pregnancy
• Cretinism
PATIENT MUST BE EUTHYROID BEFORE THYROIDECTOMY
TYPES OF THYROIDECTOMY
1. Hemi-thyroidectomy-lobectomy
• Remove the lobe and the isthmus
2. Subtotal thyroidectomy
• Leave 4g on either side of the glands
3. Near total thyroidectomy
• Remove all and leave 4g on either side
4. Total thyroidectomy
• Remove both lobes and the isthmus
Complications of thyroidectomy
• Hemorrhage
• Obstruction-tracheomalacia,
• Injury to the nerves
• Hypothyroidism
• Wound infection
• Hypoparathyroidism
• Thyroid storm
COMPLICATIONS-THYROID STORM
• ICU admission
• O2
• Rehydration by rapid IVF fluid
• Cold tepid sponging
• Propranolol
• Hydrocortisone
• Carbimazole or propyl thiouracil
• In pite of above intervention mortality is high
Pearls of Wisdom