Disorders of the thyroid gland Flashcards
Differential for midline neck swelling
Thyroid enlargement
Submental LN
Thyroglossal cyst
Differentials for lateral neck swelling
Cervical LN Salivary gland enlargement Branchial cyst Cystic hygroma Pharyngeal pouch Carotid body tumour
In whom is a physiological goitre relatively common
Puberty
Pregnancy/ Lactation
What is a goitre associated with in Pendred syndrome
deafness
List some goitrogens
anti-thyroid drugs, PAS, sulphonylureas, iodine containing medications, cobalt
What can cause non-toxic smooth diffuse thyroid enlargement
Physiological, genetic, endemic, thyroiditis
Types of thyroiditis
Hashimoto
de Quervain
Riedl thyroiditis
Poor prognostic factors for thyroid Ca
Older patients, males, undifferentiated lesions, capsular invasion, extraglandular spread and lymphadenopathy.
TNM staging for thyroid Ca
T1 (single nodule), T2 (multiple nodules or both lobes involved), T3 (extraglandular spread); N1 (nodal involvement), M1 (metastases).
Causes of solitary thyroid nodule
Hyperplastic/adenomatous nodule (60%) Follicular adenoma (20%) Simple cyst (10%) Thyroid Ca (5-10%)
What system is used to classify thyroid cytopathology
Bethesda
Tests used to investigate thyroid nodules
U/S Aspiration cytology Radioisotype scanning CT (for retrosternal spread Bloods
Which thyroid cancer is managed more conservatively?
Papillary Ca
What are the indications for surgery with a multinodular goitre
Compression (Resp probs, retrosternal, suoerior mediatinum syndrome)
Sometimes cosmetic
Concern of malignancy
Features suggestive of malignancy in a thyroid mass
Asymetrical/ solitary nodule (kids and men) Rapid onset Increase in size Pain Local invasion LN Hoarseness
Types of thyroid Ca
Well-differentiated (papillary/ follicular)
Medullary
Anaplastic
Lymphoma
Features of papillary thyroid Ca
Small nodule (sometimes multifocal)
TSH dependant
Lymphatic spread
Features of follicular thyroid Ca
Larger single nodue
Haemotogenous spread (bone and lung)
I(131) sensitive
From which cells do medullary thyroid Ca arise
“C” cells
Causes of thyrotoxicosis
Common - Grave’s, Toxic MNG (plummer’s) and toxic solitary nodule (toxic adenoma)
Uncommon - Excess TSH (pituitary), T4 (paraneoplastic), iodine (Jod Basedow)
Treatment of thyrotoxicosis
Medical - Neomercazole, propanalol
Radiotherapeutic - I131
Lastly surgery
Complications of thyriod surgery
Structural - Nerve damage, laryngeal oedema, haemorrhage, tracheomalacia
Endocrine - Hypoparathyroid, hypothyroid, thyroid crisis
