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Thyroid Disease M. Alhashash MD 1. Anatomy Over Trachea Two Lobes connected together by an isthmus 15 to 20 g.

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Presentation on theme: "Thyroid Disease M. Alhashash MD 1. Anatomy Over Trachea Two Lobes connected together by an isthmus 15 to 20 g."— Presentation transcript:

1 Thyroid Disease M. Alhashash MD 1

2 Anatomy Over Trachea Two Lobes connected together by an isthmus 15 to 20 g

3 Sites of normal & ectopic thyroid tissue 3


5 Arterial supply Superior thyroid artery Inferior thyroid artery Thyroida ima artery Anastomosis with esophagus and trachea 5

6 Venous drainage Superior thyroid vein IJV Middle thyroid vein IJV Inferior thyroid vein innom. V. 6

7 Lymphatics Direct : Upper and lower deep cervical LN Indirect : – Pretracheal LN – Paratracheal LN – Inferior and superior thyroid veins LN 7

8 Nerve supply Sympathetic (blood supply) Parasympathetic (RLN) 8

9 Thyroid Regulation 9

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 10

11 TFTs TSH is the screening test of choice for thyroid function (nml 0.3-5mU/L) T4 T3 Antithyroglobulin (TSAb) 11

12 Evaluation of Thyroid Diseases 1.Clinical history and physical examination 2.Serum T3 & T4, TSH determination 3.Thyroid scan (RAIU) 4.Thyroid ultrasound 5.Plain x-ray, CT scan / MRI 6.FNAC 7.Sleeping pulse & laryngoscope. 12

13 THYROID GLAND DISORDERS I.CONGENITAL II.SIMPLE A.Diffuse : 1-physiological 2- colloid B.Nodular 1-multinodular 2- solitary III.Toxic A.Primary B.Secondary IV.Neoplastic A.Benign B.Malignant. V.Inflammatory 13

14 Answer the following questions: (time allowed 5 minutes) A.Enumerate types of shock: B.Define: 1.Epistaxis: is……………………………………….. 2.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) 15

16 Sites of normal & ectopic thyroid tissue 16

17 Congenital anomalies 2 Anomalies of thyroglosal tract – Thyroglossal cyst – Thyroglossal fistula(sinus) 17

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) 18

19 Stress leads to dec. T3 & T4  increase TSH  physiological goiter. I.Stress over --> normal gland II.Prolonged stress  exhaustion of the gland  diffuse colloid goiter and after time  nodular colloid goiter. III.Stress repeated  fibrosis  simple multinodular goiter. 19

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. 20

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) 21

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