Thyroid Flashcards
Arterial supply to thyroid
inferior and superior thyroid arteries
thyroidia ima artery may be present
Veins to the thyroid
Superior Inferior Middle thyroid veins
Lymph drainage of thyroid
Pre tracheal, lrelaryngeal and paratracheal nodes
eventually drain into the thoracic duct
nerves by the thyroid
external laryngeal nerve - passes MEDIALLY to the superior portion of the thyroid glad to innervate cricothyroid
Recurrent laryngeal nerve- lies in groove b/w trachea and oesophagus and emerging medially to the inferior part of the thyroid
what are the names of acute, subacute and chronic thyroiditis
Acute - acute inflammation of the thyroid glad
Sub-acute - De QUervians
Chronic - Redials
why does MAiodarone cause hyper and hypo thryoidism
due the inhibition of monodeiodination of T4 (which reduces T3) , the blocking of T3 receptors and a direct toxic effect leading to follicular destruction
iodine deficiency 0 what will thyroid be like
multi nodular cyst
thyroidglossal fistula
ddx for midline neck swelling
thyroid isthmus
thyroidgloassal duct cyst
Anterior triangle Ddx
- Thyroid (MNG, solid - B or M , physiological, iodine deficiency, pregnany , puberty , inflammatory, A.I)
- Brachial cleft cyst
- Carotid body tumour (chemodectoma) - pulsate but not expansile, moves laterally and not up and down
- paraganglioma
- neuroblastoma - lipoma
- subcutaneous cyst
- sarcoma
posterior triangle of the neck
- skin
- lymph node
- bone
- cystic hygroma - multilobulated lymphangioma (congenital on left)
- parotid swelling 0 Warthrin’s tumour - adenolymphoma, benign - ass. w/ smoking
- Zener’s diverticulum AKA pharyngeal pouch
- SCM tumour - children , may cause torticolitis
inflammatory neck lumps
- Post viral LAD - >1cm, usually resolves >2 week
- bacterial - mycobacteria, acintomycin, brucellosis, cat scratch disease
- HIV
malignant neck swelling
metastatic - lung ,esophagus, breast
thyroid
Salivary glad
Lymphoma
causes of thyroidtoxicosis
- Graves
- TMN
- Solitary toxic nodule
- thyroiditis (hashimoto’s , de quervain’s, post part)
- drugs - amiodarone
RF of thyroidtoxicois
- A. fib
- osteoporosis
- thyroid storm
define graves
autoimmune syndrome consisting of hyperthyroidism, goitre and pretibial/ localizing myxoedema. It is disease characterized by the presence of TSH receptor antibodies and most commonly occurs in women in their 3rd and 4th decade of life
when do you use PTU for Graves
only in ppl who can’t tolerate carbimazole being lowered
use for 18 months
side effect of radio-iodine
- hypothyroidism
- thyroiditis
- transit worsening of graves opthalmopathy
Hartley Dunhill procedure
when you removed entire lobe on one side, and only subtotal thyroidectomy on the other side - MOST COMMON SURGERY
Graves opthalmopathy - what type of surgery
total thyroidectomy
when can you consider doing thyroid surgery
patient MUST be euthyroid prior to surgery - to decrease vascularity of gland
Papillary RF, Pathological findings , mets and prognostic factors
RF - Radiotherapy, Fam History
Path : Orphan Annie Nuceli , psammoma bodies, nuclear groove
Mets: 2-10% , 2/3 - lung, 3/4 - skeletal system, rare - brain liver kidneys and adrenal
Prognostic
Good: age - young, Small size
Bad: mets, soft tissue Invasion
Follicular RF, Pathological findings , spread and mets
Rf: Family history, radiotherapy, iodine
path: capsulated , colloid present , hurtle cells
HEMATOGENOUS SPREAD
skeletal system and lungs
Rare: brain liver, bladder , skin
Mets = Hormonally active - HYPERTHYROIDism
MEDULLARY definition , path, inherited
neuroendocrine tumour of parafollicular or C cells of the thyroid
Normal function test
increase calcitonin level - deposits as amyloid (flushing, diarrhea)
Inheritance:
1. sporadic - single nodule and often cervical LAD
2. Familial - Men 2 a, Men 2b
anaplastic
undifferentiated tumours of thyroid follicle epithelium in older women, agree , palliative chemo and radio for symptoms
types of thyroid lymphoma
- diffuse B cell NHL
- maltoma
- hashimoto’s thyroiditis
when do you remove cervical nodes in thyroid cancer
- when they have a palpable node
2. papillary carcinoma
Early complications of thyroidectomy
- Strap hematoma, transient hypoparathyroidism (8%), hypocalemia, side effect of anaesthesia, serum, larygenal nerve injury, vocal cord paresis
H3 VANS
late complications of thyroidectomy
permanent hypoparathyroidism