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Y3R6: Surgery I 👨‍⚕️ > L2: Simple Goiter > Flashcards

L2: Simple Goiter Flashcards

1
Q

Normally → Thyroid gland is …….

A

impalpable

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2
Q

If there is Swelling/Enlargement of the thyroid gland, it may be maybe..

A
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3
Q

Classifications of thyroid enlargement

A
  • Simple (Euthyroid)
  • Toxic
  • Neoplastic
  • Inflammatory
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4
Q

Simple (euthyroid) thyroid enlargment

A
  • Diffuse hyperplastic
  • Colloid goiter
  • Nodular goiter (Multinodular).
  • Solitary nontoxic nodule.
  • Recurrent nontoxic nodule.
  • Wolff-Chaikoff effect
  • Hokkaido goiter
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5
Q

Causes of Diffuse hyperplastic thyroid enlargment

A
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6
Q

Wolff-Chaikoff effect

A
  • Intake of large quantity of iodides → inhibits the further release of thyroid hormones (inhibits organification) by autoregulatory mechanism.
  • But later: may cause escape phenomenon.
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7
Q

Hokkaido goiter

A

Hokkaido is a northern island in Japan where iodine-rich seaweeds are the main diet intake causes goiter in these individuals

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8
Q

Toxic Thyroid Enlargment

A
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9
Q

Neoplastic Thyroid Enlargment

A
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10
Q

Inflammatory Thyroid Enlargment

A
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11
Q

Etiology of Simple Goiter

A
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12
Q

TSH is not the only stimulus to thyroid follicular cell proliferation

A

..

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13
Q

Causes of lodine deficiency

A
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14
Q
  • Calcium is also goitrogenic.
  • Goiter is common in low-iodine areas on chalk or limestone.
  • Dietary deficiency of iodine is the most important factor in endemic goiter.
A

..

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15
Q

Dyshormonogenesis

A
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16
Q

Examples of goitrogens

A
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17
Q

How do goitrogens act?

  • Thiocyanates & perchlorates
A

interfere with iodide trapping.

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18
Q

How do goitrogens act?

  • Carbimazole & thiouracil compounds
A

interfere with:
* Oxidation of iodide
* Binding of iodine to tyrosine.

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19
Q

How do goitrogens act?

  • lodides in large quantities
A
  • inhibit organic binding of iodine and produce an iodide goiter
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20
Q

Excessive iodine intake may be associated with increased incidence of autoimmune thyroid disease

A

..

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21
Q

Stages of goiter formation
(The natural history of simple goiter)

A
  • Formation of Diffuse hyperplastic goiter
  • Formation of nodular goiter
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22
Q

Formation of Diffuse hyperplastic goiter

A
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23
Q

Formation of nodular goiter

A
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24
Q
  • Most nodules are inactive.
  • Active follicles are present only in the internodular tissue.
  • The heterogeneous structural & functional response in the thyroid resulting in characteristic nodularity may be due to Presence of clones of cells particularly sensitive to growth stimulation.
A

..

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25
Q

Types of Simple Goiter

A
  • Diffuse Hyperplastic Goiter
  • Nodular Goiter
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26
Q

Pathogenesis of Diffuse Hyperplastic Goiter

A
  • Diffuse hyperplasia corresponds to the first stages of the natural history.
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27
Q

Epidemeology of Diffuse Hyperplastic Goiter

A
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28
Q

CP of Diffuse Hyperplastic Goiter

A
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29
Q

Fate of Diffuse Hyperplastic Goiter

A
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30
Q

Pathogenesis of Nodular Goiter

A
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31
Q

Types of Nodular Goiter

A
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32
Q

Epidemeology of Nodular Goiter

A
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33
Q

Pathology of Nodular Goiter

A
  • Nodules may be Colloid or cellular.
  • Cystic degeneration & hemorrhage are common, as is subsequent calcification.
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34
Q

CP of Nodular Goiter

A
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35
Q

Suspicion of carcinoma in Nodular Goiter if ……

A
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36
Q

DDx of Nodular Goiter

A

Autoimmune thyroiditis.

  • Differential diagnosis may be difficult & the two conditions frequently coexist.
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37
Q

Investigations for Nodular Goiter

A
  • Thyroid function test & thyroid
    Antibodies
  • Ultrasonography
  • Fine Needle Aspiration Cytology [FNAC]
  • Plain radiographs [X-rays]
  • CT
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38
Q

Thyroid Function Tests & Thyroid Abs in Nodular Goiter

A

To Differentiate it from thyroiditis.

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39
Q

US in Nodular Goiter

A

The gold standard assessment when undertaken by a suitably trained and experienced operator

40
Q

FNAC in Nodular Goiter

41
Q

Plain Radiographs (X-Ray) in Nodular Goiter

A

X-Ray of the chest and thoracic inlet

42
Q

CT in Nodular Goiter

A

CT neck & chest:

  • It’s the best modality to assess Tracheal or esophageal deviation or compression, if there are swallowing or breathing symptoms.
43
Q

Complications of Multinodular goiter

44
Q

Lines of treatment of simple goiter

45
Q

How to deal with Endemic goiter?

A

Introduction of iodized salt, In endemic areas

46
Q

How to deal with Hyperplastic Goiter?

A

In the early stages, a hyperplastic goiter may regress if thyroxine is given in a dose of 0.15-0.2 mg daily for a few months.

47
Q

How to deal with multinodular Goiter?

A

Most patients with multinodular goiter are asymptomatic & do not require operation, except:

  1. Cosmetic grounds
  2. Pressure symptoms
  3. As response to patient anxiety.
  4. Retrosternal extension with tracheal compression
  5. Presence of a dominant area of enlargement that may be neoplastic.
48
Q

Incidence of Clinically Discrete Swellings

A
  • Common condition.
  • Sex: in women > men (by 3 to 4 times).
49
Q

Etiology of Clinically Discrete Swellings

50
Q

Dx of Clinically Discrete Swellings

51
Q

The importance of discrete swellings: lies in the risk of neoplasia compared with other thyroid swellings.

  • 15% of isolated swellings prove to be malignant.
52
Q

Investigations for Clinically Discrete Swellings

A
  • Thyroid Function Tests
  • Autoantibody Titers
  • Isotope Scan
  • US
  • FNAC
  • Radiology
  • Laryngoscope
  • Core Biopsy
53
Q

Thyroid Function Tests in Clinically Discrete Swellings

54
Q

Antibody Titers in Clinically Discrete Swellings

55
Q

Importance of Isotope Scan in Clinically Discrete Swellings

A

It’s the mainstay of investigation to determine the functional activity relative to the surrounding gland according to isotope uptake.

56
Q

Routine isotope scanning has been abandoned except when

A

toxicity is associated with nodularity.

57
Q

On scanning, swellings are categorized as

58
Q

Importance of US in Clinically Discrete Swellings

A
  1. Can demonstrate subclinical nodularity and cyst formation.
  2. Also used for FNAC.
59
Q

US findings in thyroid swelling suggestive of neoplasia

A
  1. Microcalcifications
  2. Increased vascularity by doppler.
  3. Only macroscopic capsule breach & nodal involvement are diagnostic of malignancy.
60
Q

How to use FNAC in Clinically Discrete Swellings?

A

FNAC should be used, ideally under ultrasound guidance.

61
Q

When to Use FNAC in Clinically Discrete Swellings?

A

on all nodules that do not fulfill a fully benign (U2) classification on ultrasonography.

62
Q

Advantages of FNAC in Clinically Discrete Swellings

63
Q

FNAC Can Diagnose …..

64
Q

Disadvantages of FNAC in Clinically Discrete Swellings

65
Q

FNAC cannot distinguish between a benign follicular adenoma & follicular carcinoma, Why?

A

This distinction is dependent not on cytology but on histological criteria, which include capsular & vascular invasion.

66
Q

Radiology in Clinically Discrete Swellings

67
Q

Chest & thoracic inlet radiographs in Clinically Discrete Swellings

68
Q

CT & MRI scans in Clinically Discrete Swellings

69
Q

PET CT scan in Clinically Discrete Swellings

A

May be useful in:
- Localizing disease which does not uptake radioiodine.

70
Q

Flexible laryngoscopy has rendered indirect laryngoscopy obsolete.

71
Q

Importance of Laryngoscope in Clinically Discrete Swellings

A
  1. Medicolegally: is widely used preoperatively to determine the mobility of the vocal cords for medicolegal rather than clinical reasons.
  2. In Diagnosis of malignant disease: The presence of a unilateral cord palsy with a swelling suggestive of malignancy is usually diagnostic.
72
Q

In Diagnosis of malignant disease: The presence of a unilateral cord palsy with a swelling suggestive of …….

A

Malignancy

73
Q

Core Biopsy in Clinically Discrete Swellings

74
Q

How To Deal With Nontoxic benign nodule?

A
  • Treated with observation without any therapy.
  • Follow up with: annual clinical examination & ultrasound neck.
75
Q

How To Deal With Solitary toxic nodule?

A
  1. Initially → antithyroid drugs.
  2. Then → Radioactive iodine therapy.
76
Q

How To Deal With Colloid nodule?

A
  1. Can be observed.
    OR
  2. Hemithyroidectomy → Done for cosmosis.
77
Q

How To Deal With Papillary carcinoma of thyroid?

A
  • Then, Total or near total thyroidectomy with or without radioactive iodine & hormonal replacement.
78
Q

How To Deal With Follicular adenoma?

A

-Then, Hemithyroidectomy

  • Then, Total thyroidectomy → if found malignant pathologically.
79
Q

How To Deal With Medullary carcinoma of thyroid?

A
  • Then, Total thyroidectomy with bilateral neck nodal dissection including central compartment.
80
Q

Indications of surgery in Clinically Discrete Swellings

81
Q

There are useful clinical criteria to assist in selection for operation according to the risk of neoplasia and malignancy:

82
Q

Epidemeology of Thyroid Neoplasia

83
Q

Def of Retrosternal Goiter

84
Q

Etiology of Retrosternal Goiter

85
Q

Types of Retrosternal Goiter

86
Q

Symptoms of Retrosternal Goiter

87
Q

Signs of Retrosternal Goiter

88
Q

Investigations in Retrosternal Goiter

89
Q

X-Ray in Retrosternal Goiter

90
Q

CT Scan in Retrosternal Goiter

91
Q

TTT of Retrosternal Goiter

92
Q

Def of Thyroid Incidentaloma

A

Clinically unsuspected and impalpable thyroid swellings.

93
Q

Managment of Thyroid Incidentaloma

A

The majority of impalpable thyroid swellings can be safely managed by a single annual review, with no intervention unless:

A. Certain criteria are met.

B. OR the swelling becomes palpable.

94
Q

Def of Thyroid Cyst

A

Thyroid swelling which is cystic in nature & elicit positive fluctuation.

95
Q

Etiology of Thyroid Cyst

96
Q

Managment of Thyroid Cyst

97
Q

Breathing difficulties in thyroid swelling

Y3R6: Surgery I 👨‍⚕️ (36 decks)

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