1 / 21

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

faris
Télécharger la présentation

Thyroid Disease

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  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)

More Related