General Thyriod Disorders Flashcards by Mubarak Osman

Where is the thyriod gland located?

Neck

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What is the Shape of the thyriod gland?

Shield shaped

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What is the thyriod cartillage commonly know as?

Hint: when you swallow it moves- if you’re a guy

Adam’s apple

The thyriod gland is located underneath the thyriod cartillage

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What complications are there in a surgery involving the whole or part of the thyriod gland being removed?

Has a profound blood supply so it bleeds alot if you remove half a thyriod- has many blood vessels

A whole thyriod- less complications- clamp arteries

Damage to the Left recurrent laryngeal nerve ( vocal cord supply)- risk of cutting it during surgery- can change the tone of your voice.

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lable the diagram below

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What is the isthmus?

The two wings or lobes on either side of the windpipe are joined together by a bridge of tissue, called the isthmus, which crosses over the front of the windpipe.

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Name all the lobes in the thyriod gland and which one is the largest?

Lable the diagram below

Right- Largest

Left

Pyrimidal

Isthmus

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What are the names of the glands located within the thyriod gland?

How many of these glands are there within the thyriod gland?

What do they do?

Parathyriod Gland

The parathyroid glands are four tiny glands, located in the neck, that control the body’s calcium levels.

Each gland is about the size of a grain of rice (weighs approximately 30 milligrams and is 3-4 millimeters in diameter).

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What is the origin of the thyriod?

Back of the tongue

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What is the adult weight of a thyriod gland?

20g

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Describe the embryology of the thyriod gland?

The thyriod gland start of at the back of the tongue. So when you are 7 week in utero, the tongue forms a little outpouching and a little lump appers and if you look at a normal tongue at an adult you see a little dimple at the back. That is where the tyriod gland started. The thyriod gland descends through a long little tube as a few cells and when it gets to the right place it grows.

It is important because sometimes the thyriod gland doesn’t descent properly leaving lumps in the neck.

Midline outpouching if floor of pharync (ie base of tongue is origin)

Outpouching forms a duct which elongates down (thyroglossal duct)

MIgrates down neck and devides into two lobes

Final position by 7 weeks

The duct dissappears leaving the foramen caecum (dimple in the back of the tongue)

The thyriod gland then develops

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What is the foramen caecum

Dimple in the back of the tongue

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What is the average size of each lobe?

Express as Number x number x number cm

4x 2.5 x 2.5 cm

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What lobe is the larger lobe in the thyroid gland?

right

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Why is the pyramidal lobe useful in imaging?

Help identify the thyroid gland because it is easy to identify the pyramidal lobe

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Name the disease in which there is no thyriod gland?

What is the prevalence of Thyriod agenesis?

Thyriod agenisis

1 in 4000 babies have this disease

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Name 3 problems of the thyriod gland that is due to abnormal development?

Agenesis (complete abscence)

Incomplete Descent (ie base of the tongue to trachea)

Thyroglossal Cyst (Segment of the duct persists and presents as a lump years later)

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What is a thyroglossal cyst?

Segment of the duct persists and presents as a lump years later- can be painful

A thyroglossal cyst is a fibrous cyst that forms from a persistent thyroglossal duct. Thyroglossal cystscan be defined as an irregular neck mass or a lump which develops from cells and tissues left over after the formation of the thyroid gland during developmental stages.

Cyst- fluid-filled sacs

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What is lingual thyroid?

A lingual thyroid is a specific type of ectopic thyroid and results from the lack of normal caudal migration of thethyroid gland

Ectopic- in an abnormal place or position.

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What happens if a neonate has thyroxine deficiency in utero ?

What is the name of this disease?

The thyroxine deficiency can be due to a lack of iodine in the diet

Irreversible brain damage

Cretinism

Cretenism Before and After

How is cretenism prevented?

All babies have a heel prick for a blood test for thyroid function- MEASURING TSH - at the same time as the Guthrie test (for phenylketonuria) at 5-10 days of age

What happens if a neonate has high levels of TSH?

Given Thyroxine immediatly

What cells is thyroxine produced in?

Thyriod follicular cells

What 2 things does the colloid contain?

Stored Thyroxine Stored Thyroglobulin

Thyroxine binding globulin (aka throxine binding protein) binds to ..... of throxine in the circulation.

75% Thyroglobulin is inside the thyroid gland?

What are the tiny white dimples in the image below?

It is where TSH has activated some cells and some thyroxine has entered the blood vessel If the thyroid is very active is has many of these white dimples.

What proportion of the population has a thyroid disease?

What is the ratio for men to women who have thyroid diseases?

4:1 Thyroid diseases are MORE COMMON IN WOMEN Autoimmune conditions are common in women

What is the ratio of underactive thyroid diseases to overactive thyroid diseases?

1:1

What is primary hypothyroidism also known as ?

Myxoedema

What causes Myxoedema?

Autoimmune damage to the thyroid

What is primary hypothyroidism ( myxoedema)?

Primary thyroid failure Autoimmune damage to thyroid Thyroxine levels decline TSH levels climb

What are the levels of TSH with a patient with myxoedema?

TSH levels are high

Myxoedema before and After

What does THR stand for?

Thyrotropin releasing hormone

List 6 features of Primary Hypothyroidism?

Deepening Voice Depression and Tiredness Cold intolerance Weight gain with reduced appetite Constipation Bradycardia- Bradycardia is a condition wherein an individual has a slow heart rate,

What is a myxoedema coma?

Myxedema coma is a state of decompensated hypothyroidism. A person may have lab values identical to a "normal" hypothyroid state, but a stressful event (such as an infection, myocardial infarction or stroke) precipitates the myxedema coma state, usually in the elderly. Myxedema coma is a loss of brain function as a result of severe, longstanding low level of thyroid hormone in the blood (hypothyroidism).

Why are patients with hypothyroidism my liely to suffer from heart attack and strokes?

High cholesterol because their body is not using cholesterol.

What is the treatment of primary hypothyroidism?

Thyroxine -T4- usually one tablet daily- 100 micrograms Monitor TSH nad adjust dose until TSH is normal

What is an alternative name for hyperthyroidism?

Thyrotoxicosis

What are the signs and symptoms of Hyperthyroidism?

Myopathy- muscle weekness Mood swings Feeling hot in all weathers Diarrhoea Increased appetite but weight loss Tremor of Hands Palpitations Sore eyes- due to Graves disease Goitre

Name a common disease which causes hyperthyroidism?

Graves disease

What does Graves disease do to the neck? What is the name of this formation?

Goitre

What type of disease is graves disease?

Autoimmune

What is the pathophysiology of Graves Disease?

Autoimmune condition Antibodies bind to nad stimulate TSH receptor in the thyroid

What other problems besides hyperthyroidism can Graves disease cause?

Exophthalmos- other antibodies bind to muscles behind the eye and cause EXOPHTHALMOS Other antibodies stimulate growth of the shins and cause PRETIBIAL MYXOEDEMA (hypertrophy)

What is exophthalmos?

Exophthalmos (also called exophthalmus, exophthalmia, proptosis, or exorbitism) is a bulging of the eye anteriorly out of the orbit.

What is PRETIBIAL MYXOEDEMA?

The swelling- **NON PITTING** - that occurs on the shins of patients with graves' disease