Thyroid And Neck Swellings Flashcards
goitre définition
Swelling of the thyroid
Goitre classification
Simple
Toxic
Neoplastic
Inflammatory
Infective
Others
What is simple goitre
Diffuse hyperplasia due to increased physiological demand like puberty or pregnancy, iodine deficiency , medications ( amiodarone, lithium)
Population at risk of multinodular goitre
Middle aged women
Chances of malignancy of multinodular goitre
5%
Complications of multinodular goitre
hyper/hypothyroidism
Hemorrhage
Nodule rupture
Malignancy
Tracheal compression / deviation
Oesophageal compression
SVCO
Man causes of toxic goitre
Graves disease
Other causes toxic goitre
Thyroiditis
Carcinoma
TSH secreting pituitary tumor
Iatrogenic
Choriocarcinoma
Hydatidiform mole
Types of benign tumor
Adenoma
Follicular tumor
Primary malignant tumor
Papillary carcinoma
Follicular carcinoma
Medullary thyroid cancer
Anaplastic thyroid cancer
Lymphoma
Type of inflammatory goitre
Autoimmune (hashimoto disease)
Granulomatous thyroiditis
Types of infective goitre
Acute bacterial thyroiditis
Chronic tb
Viral thyroiditis sub acute
WHO goitre grading
0 = no palpable goitre
1 = palpable goitre
1A = goitre detectable by palpation
1B = goitre palpable and visible
2= goitre visible with neck in normal position
3= large goitre from distance
Investigations
Thyroid function tests
Autoantibody screen
Tumour markers : calcitonin
Ultrasound : consistency, nodule number, size, position
Chest x ray : tracheal compression
CT, MRI => size, anatomy, retrosternal extension
Radionuclide imaging
FNAC
Treatment
Thyroxine
Radioiodine (thyrotoxicosis, euthyroid with large goiters)
Tetracycline ( cystic recurrence )
Thyroidectomy
Lobectomy
Post operative complications
Hemorrhage
Tracheal compression
Nerve damage
Temporary Hypocalcemia
Parathyroid injury or excision
Wound infection
Recurrence
Thyroid storm
Neck swellings
Sebaceous cyst
Lipoma
Neurofibroma
Capillary malformation
Tumors (SCC, melanoma, secondary metastasis )
Muscular neck swellings
Sternomastoid tumor
Rhabdomyosarcoma
Fibroma
Lymphadenopathy neck swellings
Acute infective
Chronic infective
Primary malignant
Secondary malignant
Commonest congenital neck swelling
Thyroglossal cyst
Thyroglossal cyst cause
Persistence of any part of Thyroglossal duct
Characteristics Thyroglossal cyst
Non tender
Between thyroid and hyoid
Transilluminate
Treatment Thyroglossal cyst
Excision
What is Cystic hygroma
Congenital benign lymphangioma
Characteristics of cystic hygroma
Neck and floor of mouth
No spontaneous regression
Clear lymph fluid
Transilluminates
Treatment cystic hygroma
Surgical removal
Sublingual Dermoid cyst bulge all the time ?
No can be wholly intra oral
Bronchial cyst occurs mostly before or after adolescence
After
Causes of branchial cyst
Failure of fusion of 2nd and 3 branchial arches
Treatment branchial cyst
Excision
Examination inspection
Site location
Asymmetry
Color changes
Sinuses
Scars
Punctum
Movement on swallowing
Examination palpation
Induration
Tenderness
Temp
Mobility
Limits definition
Pulsatility
Emptying
Consistency
Systematic back of the neck
Cranial nerve assessment
Direction of movement
Transillumination
Investigations
Radio. - plain x ray , ct, mri , sialography, ultrasound, barium swallow
Angiography
Immune studies
Bone scan
Histopathology - FNAB, biopsy
Hemato - FBC, ESR, CRP
Microbiology - AFBs, STIs
What are the three strap muscles , fixing the lobes of thyroid to cartilage
Sterno thyroid muscle
Sternohyoid muscle
Superior belly of omohyoid
The postero lateral surface of each lateral lobe of the thyroid gland is related to which structure
Carotid sheath
Tractors related to the medial border of the lobes of the thyroid gland
Inferior constrictor
cricothyroid muscles
Oesophagus
Upper six tracheal rings
recurrent laryngeal nerve
Two hormones produced by thyroid gland
T3 tri iodothyronine
T4 thyroxine
Function of thyroid hormones
Increase heart rate , contractility of heart, cardiac output
Glycogen to glucose
Glucose absorption
Lipogenesis , lipolyses
CNS function
Growth , maturation
Amount of iodine in gland
5000mg
90% storage of body
Amount of iodine secreted by gland
100-120 microgram
Main tests of thyroid function
In vitro test :
Serum t3 concentration
Serum free thyroxine
Serum thyroid stimulating hormone TSH
Test of hypothalamic pituitary axis
Most sensitive indicator of hypothyroidism
Serum t3
Most sensitive test for hypothyroidism
Serum TSH
In vivo test
Isotope uptake test : high in hyperthyroidism , low in hypothyroidism
TSH stimulation and uptake test
Imaging techniques used
Plain x ray - soft tissue and calcification
Ultrasound scan
CT
MRI
Fine needle aspiration
Test for auto immune antibodies
Laryngoscopy
