Lumps

Question 1

What is a goitre?

Answer 1

An enlargement of the thyroid gland

Question 2

What are the causes of a goitre?

Answer 2

Diffuse:
Physiological - puberty, pregnancy 
Autoimmune - Graves, hashimotos 
Inflammatory - De Quervain's thyroiditis, Riedel's thyroditis 
Iodine deficiency 
Drugs - carbimazole/ propylthiouracil 
lymphoma

Multinodular:
Mutlinodular colloid - usually euthyroid
Toxic - same as above but hyperthyroid

Single lesion:
10% malignant
Cysts
Adenoma

Question 3

What are the indications for thyroidectomy?

Answer 3

Pressure symptoms, relapse hyperthyroidism after >1 course of treatment, carcinoma, cosmetic, symptoms + planning pregnancy

Question 4

What structures are close to the thyroid that need to be considered when operating?

Answer 4

Recurrent laryngeal nerve
Superior laryngeal nerve,
Parathyroids
Trachea 
Common carotids
Internal jugular

Question 5

What are the complications of thyroid surgery?

Answer 5

Recurrent laryngel nerve palsy - permanent in 0.5% transient in 1.5%. causes hoarseness to voice

Haematoma - can cause trachea obstruction

Hypoparathyroidism - hypocalcaemia (2.5% permanent)

Hypothyroidism

Thyroid storm

Question 6

What are the differentials for a midline lump in the neck?

Answer 6

Dermoid cyst - if 20 yrs

Chrondroma - if hard and bony

Question 7

What are the borders of the submandibular triangle and what are the differentials for a lump in it?

Answer 7

Mental process, mandible and the line between the two angles of the mandible.

Lymphadenopathy - 20yrs rule out malignant
TB
Salivary stone - causes pain and swelling on eating
Sialadenitis - inflammation of salivary gland
Tumour - 80% parotid, 80% pleomorphic adenomas, 80% in superficial lobe

Question 8

What are the borders of the anterior triangle and what are the differentials for a lump in it?

Answer 8

Midline, anti border of SCM and the line between the two angles of the mandible.

Multiple - lymph nodes

Single:
Move on swallowing? YES = thryroid
NO =
Branchial cyst - ant border of SCM, 40yrs
Laryngoceles - painless, worse on blowing
Carotid aneurysm or tumour

Question 9

What are the borders of the posterior triangle and what are the differentials for a lump in it?

Answer 9

Behind SCM, and infront of trapezius, above clavicle

Cervical ribs 
Pharyngeal pouches 
Cystic hygromas - arise from jugular lymph sac, usually in infants 
Pancoasts tumour 
Subclavian artery aneurysm