BLOOD SUPPLY : Sup.Thyroid a---ext. carotid artery Inferior thyroid a---thyrocervical trunk Thyrodea ima a----arch of aorta *Sup.thyroid vein----Int. jugular v. *Middle. Thyroid vein----Int. jugular v. *Inf. Thyrod vein------brachiocephalic v
*The recurrent Laryngeal nerve *Ext.branch of sup. Laryngeal nerve History :.Evidence of Hypo or Hperfunction.Symptoms related to pressure on the neighboring structure: dysphagia,dyspnia,chocking sensation..Change in voice.Presence of massduration -rate of growth -pain
H/O: >Exposure to radiation. >Diet. >Drugs e.g para amino salycilic acid Thiouracil,Carbimazole
Thyroid Function Tests: TSH (0.5 TO 4.0 U/ml ) TSH (0.5 TO 4.0 U/ml ) increase in hypothyroidism increase in hypothyroidism decrease in hyperthyroidism decrease in hyperthyroidism T3 AND T4 T3 AND T4 Radioactive iodine uptake Radioactive iodine uptake Antithyroglobulin &antimicrosomal Antithyroglobulin &antimicrosomal
Hypothyroidism: Causes: 1)Spontaneoushypothyroidism(Myexedema ) 2)Replacement of the gland by nonfunctional goiter,adenoma, or thyroiditis 3)Post thyroidectomy 4)Post radioactive iodine therapy 5)Hashimotos thyroiditis
Clinical Features:.Increasing fatigue and apathy.Physical and mental procedures are slowed.Headaches and dementia.Weight gain.The skin becomes dry, thickened, and puffy.The hair becomes dry and brittle.The tongue is enlarged and the voice is hoarse.Pulse is slow.Congestive heart failure.
.Constipation and changes in bowel habits.Menorrhagia.Libido Treatment : L-thyroxine
Clinical Manifestations : -Goiter. -Symptoms and Signs related to excess amount of thyroxin. -Eye signs: *Lid Lag and Lid Retraction. *Ophthalmoplagia *Exophthalmos. *Supra orbital and ifra orbital swelling *Congestion and edema.
Papillary: Common 20-30 years old. -F to M 3:1 -Painless lump in the thyroid gland with enlarged lymph glands -Multicentric -Good prognosis
Follicular Ca : -30 to 40 years old. -Capsular and vascular invasion are prominent feature. -Blood metastesis
Modulary Ca : C-cell calcitonin producing tumor. -Familial. -Is part of endocrine neoplasm. -Elevated serum calcitonin.
Ana plastic : -Undifferentiated CA. -Locally invasive. -Poor prognosis. SURGERY OF THYROID. COMPLICATIONS :
PARATHYROID GLAND : Anatomy : * 4 glands *Yellowish brown in co lour *Variable in position
PTH : *It stimulates osteoclastic activity------ increasing bone resorption *Increases the reabsorption of Ca by the renal tubules *Increases absorption of Ca from the gut *Reduces the renal tubular reabsorption of phosphate
Calcitonin : secreted by the parafollicular cells of thyroid gland. It has opposite action of PTH
Hypoparathyrodism : >Commonly after total thyrodectomy >Spontaneous hypoparathyroidism. CLINICAL FEATURES : -Tingling and numbness in the face and toes -Carp pedal spasm -Strider ----------suffocation -Chevosteks sign -Trousseaus sign
Trousseaus sign Carpal spasm in response to inflation of BP cuff to 20 mm Hg above SBP for 3 min Carpal spasm in response to inflation of BP cuff to 20 mm Hg above SBP for 3 min
Chvosteks sign Elicited by tapping over facial nerve causing twitching of ipsilateral facial muscles Elicited by tapping over facial nerve causing twitching of ipsilateral facial muscles
Treatment : I.V Ca glucanate 10% 10 ml *Long term Vit. D &oral Ca.
HYPERPARATHYROIDISM : Primary : -Increase PTH -Increase Ca Due to : >Adenoma >Hyperplasia >Rarely Carcinoma Secondary : >Ch.renal failure >Malabsorption
Tertiary : Further stage in the development of reactive hyperplasia where autonomy occurs as parathyroid s no longer respond to physiological stimuli
Clinical Features : *Asymptomatic Hypercalcemia *Non specific Symptoms : muscle weakness, thirst, polyurea, anorexia, weight loss. *Bone Disease : -Generalized decalcification -single or multiple bone cysts -Loss of density and subperiosteal erosions (skull & phalanges ) _
*Renal stones : Hyperparathyrodism must be considered in patients with renal stone or nephrocalcinosis *Dyspeptic cases : Nusea, vomiting, &anorexia Peptic ulcers A.pancreatitis
* Psychiatric cases : Women complaining of tiredness or personality changes DIAGNOSIS : >Increase serum Ca >2.6 mmol /l >Decrease serum phosphorus Increase execration of Ca in urine >Increase alkaline phosphates >Increase PAT
Pre-operative Localization : Ultra sound Ultra sound CT scan CT scan Thallium-Tec subtraction scan (Tec Thy,Thalthy¶ ) enlarged Para thyroid as hot spot Thallium-Tec subtraction scan (Tec Thy,Thalthy¶ ) enlarged Para thyroid as hot spot MRI MRI Selective angiography Selective angiography Venous sampling Venous sampling Treatment : Surgery Treatment : Surgery