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Surgery Thyroid > SNG > Flashcards

SNG Flashcards

1
Q

6 years child with goiter.. first thing to come into ur mind ?

A

Dyshormonogenesis

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2
Q

What is goiter?

A

Generalized enlargement of thyroid gland

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3
Q

Dx of simple goiter clinically?

A

By exclusion

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4
Q

Early malignancy is confusing with simple so whats the next step?

A

Have to do investigations to confirm

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5
Q

What are the types of goiter? Statistically?

A
  1. Simple goiter
  2. Toxic goiter
  3. Inflammatory (thyroiditis)
  4. Neoplastic goiter
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6
Q

2 important things in every cancer u check clinically ?

A

LN and fixation

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7
Q

Goiter with weight loss?

A

Neoplastic

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8
Q

Goiter with pain?

A

Inflammatory

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9
Q

Goiter with palpation and tremor?

A

Toxic goiter

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10
Q

MC goiter is ?

A

Simple goiter

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11
Q

Thyroid hormones in simple goiter is ?

A

Normal euthyroid

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12
Q

Etiology of simple goiter?

A

Due to stimulation of thyroid gland may increase

  1. Iodine deficiency
  2. Enzymatic deficiency (dyshormonogenesis) ( pendred syndrome)
  3. Goitrogenic agents
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13
Q

Simple goiter is divided into ?

A

According to surface
Diffuse (mainly medical ttt)
Nodular (surgical ttt)

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14
Q

Why to study simple diffuse goiter when ttt is medical?

A

Cause it’s a PDF to nodular goiter

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15
Q

Most important of simple goiter?

A

Iodine deficiency ( increase demand or decrease intake)

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16
Q

What is pendred syndrome?

A

Due to peroxidase enzyme deficiency

  1. Goiter
  2. Deafness
  3. Mutism
  4. Dwarfism
  5. MR
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17
Q

Goitreous agents?

A
  1. Thiocyanate in cabbage

2. Drugs PASA and antithyroid

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18
Q

Types of simple goiter?

A
  1. Endemic goiter
  2. Physiological goiter
  3. Colloid goiter
  4. Dyshormonogenesis
  5. Sporadic goiter
  6. Simple nodular goiter (SNG)
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19
Q

Cause of endemic goiter ?

A

Deficient intake of iodine in food

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20
Q

Daily intake of iodine should be?

A

0.1 to 0.15 mg/day

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21
Q

ttt of physiological goiter is?

A

No ttt in mild cases, small dose thyroxin can be given

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22
Q

the most common thyroid disease is ?

A

SNG

23
Q

Cause of SNG?

A

Unknown so theory.. repeated fluctuation of TSH level

Recurrent hyperplasia hypervascularity and He

24
Q

PDF of SNG?

A

Diffuse goiter – nodular ( iodine deficiency )

25
Q

Nodules of SNG is active or inactive?

A

Its inactive.. the follicles present in internodular tissue is active

26
Q

How to clinically expose a patient to thyroid case?

A 
Expose head ( skull for metastasis)
Expose upper chest (dilated vein in retrosternal goiter
27
Q

Types of pt of SNG?

A

Female around 30 to 40 years (remember medical student story)

28
Q

Symptoms of SNG?

A
  1. Cosmetic disfigurement (main complain)
  2. Pressure
    a. Trachea
    b. Osophagus
    c. Carotid A
    d. IJV
    e. RLN
  3. Pain UNCOMMON only if he or in late malignancy
29
Q

Horners syndrome occurs in SNG?

A

It occurs only if malignant due to pressure or infiltration of sympathetic chain

30
Q

Where is common carodit artery?

A

Behind the thyroid gland

31
Q

Where does CCA divided?

A

Upper border of thyroid

32
Q

T3 or t4 half life is longer?

A

T4 that’s why its stored in this form

33
Q

Pulsation of carotid artery is done where?

A

Palpated against transverse process of c6

34
Q

Kocher test in SNG is done to?

A

See if trachea displaced from the middle line or tracheomalacia

35
Q

What is kocher test?

A

Slight compression on lateral lobes of thyroid produce stridor so maybe tracheomalacia

36
Q

Complications of SNG?

A
  1. Cyst formation (MC) – calcification (if long standing)
  2. Hge (most dangerous)
  3. Pressure on traches
  4. Retrosternal goiter (indication for surgery)
  5. Infection (rare)
  6. Malignant changes
  7. Secondary thyrotoxic changes in 30% cases
37
Q

Pressure manifestation in SNG?

A
  1. unilateral (kinking)
  2. bilateral (antroposterior slit – scabbard trachea)
  3. long standing nodular goiter – absorp tracheal rings ( tracheomalacia or chondromalacia) collapse
38
Q

hge in SNG?

A
  1. Precipitated by cough or shout
  2. Emergency case dt sudden compression on tracheaa – reflex spasm of pretracheal ms – acute respiratory obst and impending suffocation
  3. Ttt urgent aspiration or even emergency STT
39
Q

Malignant changes in SNG?

A

Follicular carcinoma 3%

40
Q

Investigation for SNG?

A
  1. for diagnosis
    a. thyroid fx test
    b. US (cyst, solid, single, multiple, size)
    c. FNABC (dominant nodule to exclude malignancy)
  2. exclude complication
    a. thyroid scan
    b. plain xray
  3. preoperative
    a. CBC KFT LFT FBS
    b. INDIRECT LARYNGOSCOPY MEDICOLEGAL
41
Q

When do you do thyroid scan in thyroid ?

A

If toxic.. if non toxic no need for thyroid scan

42
Q

What is the use of doing antibodies in thyroid disease?

A

Hashimoto… which is diffuse at first then nodular

43
Q

Most sensitive thyroid fx in mild cases?

A

TSH

44
Q

Normal thyroid size?

A

4L *2.5W *2 B

45
Q

Ttt of SNG?

A 
Non complicated (aim)
1.	Relieve pressure
2.	Cosmetic 
3.	Prevent complication
Complicated
1.	2ry toxic goiter
2.	Malignant changes
3.	Retrosternal extension
4.	Hge
46
Q

Ttt of noncomplicated SNG?

A
  1. Surgical
    a. Partial thyroidectomy
    b. Subtotal thyroidectomy
    c. Total thyroidectomy
  2. Non surgical
47
Q

What is partial thyroidectomy?

A

Leave the size of a normal gland (8 gm of thyroid)

48
Q

What is subtotal thyroidectomy?

A

Leave less than normal gland (4 to 5 gm of thyroid)

49
Q

Which is better? And why?

A

Total thyroidectomy and thyroixin for life is better than re exploring the neck. Cause wil be healed by fibrosis, everything white, more liable for injury (carotid sheath, RLN, trachea). Also if it turns malignant have to reopen.

50
Q

What is dunhill procedure?

A

If one lobe is more significantly involved than other, total lobectomy on the more affected side with either subtotal or partial resection on the less affected side

51
Q

Nonsurgical ttt of noncomplicated SNG?

A

In patients less than 25 years surgery is not adviced as it maybe followed by recurrence. (conservative l thyroxin)
Recently: alcohol injection in nodules – necrosis and reduction in size of gland

52
Q

Cold nodule in isotopic scan is ?

A

20% malignancy

  1. nodule of SNG
  2. non functioning adenoma
  3. cyst
53
Q

complicated SNG ttt malignant changes?

A
  1. total or near total thyroidectomy
  2. supplementary L thyroxin
  3. radioactive iodine for metastasis
54
Q

complicated SNG ttt 2ry toxic goiter?

A
  1. if <45 ( subtotal thyroidectomy after preparation)

2. if >45 ( radioactive iodine)

Surgery Thyroid (4 decks)

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